Surgical Treatment of Moderate Ischemic Mitral Regurgitation

• Published in: The New England journal of medicine Vol. 371; no. 23; pp. 2178 - 2188
• Main Authors: Smith, Peter K, Puskas, John D, Ascheim, Deborah D, Voisine, Pierre, Gelijns, Annetine C, Moskowitz, Alan J, Hung, Judy W, Parides, Michael K, Ailawadi, Gorav, Perrault, Louis P, Acker, Michael A, Argenziano, Michael, Thourani, Vinod, Gammie, James S, Miller, Marissa A, Pagé, Pierre, Overbey, Jessica R, Bagiella, Emilia, Dagenais, François, Blackstone, Eugene H, Kron, Irving L, Goldstein, Daniel J, Rose, Eric A, Moquete, Ellen G, Jeffries, Neal, Gardner, Timothy J, O'Gara, Patrick T, Alexander, John H, Michler, Robert E
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 04.12.2014
• Subjects: Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Cerebrovascular system; Coronary artery; Coronary Artery Bypass; Coronary vessels; Endocardial and cardiac valvular diseases; Female; General aspects; Heart; Heart surgery; Humans; Ischemia; Male; Medical sciences; Middle Aged; Mitral Valve Insufficiency - etiology; Mitral Valve Insufficiency - surgery; Morbidity; Myocardial Ischemia - complications; Myocardial Ischemia - surgery; Patients; Postoperative Complications - epidemiology; Quality of Life; Regurgitation; Ventricle; Ventricular Remodeling; New York; United States > US; Medicine; Mitral valve; Treatment; Ischemia; Cardiac valvular disease; Surgery; Mitral regurgitation; Cardiovascular disease
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa1410490

This trial compared coronary-artery bypass grafting alone with CABG plus mitral-valve repair in patients with coronary artery disease and moderate ischemic mitral regurgitation. Mitral-valve repair provided no apparent benefit and was associated with more neurologic complications. Each year, approximately 1 million Americans have a myocardial infarction, and nearly 8 million Americans have a history of myocardial infarction. 1 Ischemic mitral regurgitation, which results from functional-valve incompetence due to myocardial injury and adverse left ventricular remodeling, develops in approximately 50% of patients after an infarction, and moderate regurgitation occurs in more than 10% of patients. 2 – 4 Ischemic mitral regurgitation is associated with excess mortality regardless of management. 5 , 6 The valve leaflets and chordal structures in affected patients are “innocent bystanders”; mitral regurgitation results from papillary muscle displacement, leaflet tethering, reduced closing forces, and annular dilatation. 7 – 10 Many patients . . .