Pulse Brain · Growing Health Evidence Index
Tier 2 — RCT / large cohortPeer-reviewed

Two-Year Outcomes of Surgical Treatment of Moderate Ischemic Mitral Regurgitation

Robert E. Michler, Peter K. Smith, Michael K. Parides, Gorav Ailawadi, Vinod H. Thourani, Alan J. Moskowitz, Michael A. Acker, Judy Hung, Helena Chang, Louis P. Perrault, A. Marc Gillinov, Michael Argenziano, Emilia Bagiella, Jessica Overbey, Ellen Moquete, Lopa Gupta, Marissa A. Miller, Wendy C. Taddei‐Peters, Neal Jeffries, Richard D. Weisel, Eric A. Rose, James S. Gammie, Joseph J. DeRose, John D. Puskas, François Dagenais, Sandra G. Burks, Ismaı̈l El-Hamamsy, Carmelo A. Milano, Pavan Atluri, Pierre Voisine, Patrick T. O’Gara, Annetine C. Gelijns

New England Journal of Medicine · 2016

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Summary

This randomised controlled trial compared coronary-artery bypass grafting (CABG) alone with combined CABG and mitral-valve repair in 301 patients with moderate ischaemic mitral regurgitation, following patients for two years. At two years, both groups showed similar left ventricular reverse remodelling and mortality rates, though the combined procedure group had significantly lower rates of residual mitral regurgitation but higher rates of neurologic events and supraventricular arrhythmias. The findings suggest that whilst mitral-valve repair provides more durable correction of regurgitation, it does not confer survival or overall adverse-event benefits over CABG alone in this patient population.

UK applicability

These findings are relevant to UK cardiothoracic surgical practice and clinical guidance on the management of moderate ischaemic mitral regurgitation in patients undergoing CABG. The results may inform surgical decision-making in the NHS regarding the role of concomitant mitral-valve repair, though applicability depends on case selection and surgeon expertise.

Key measures

Left ventricular end-systolic volume index (LVESVI) in ml per square metre of body-surface area; mortality rate; prevalence of moderate or severe residual mitral regurgitation; hospital readmission rates; serious adverse events; neurologic events; supraventricular arrhythmias

Outcomes reported

The study measured left ventricular end-systolic volume index (LVESVI), mortality rates, prevalence of residual mitral regurgitation, and rates of adverse events at two years post-surgery. Clinical and echocardiographic outcomes were compared between CABG alone and CABG plus mitral-valve repair groups.

Theme
General food systems / other
Subject
Other / interdisciplinary
Study type
Research
Study design
RCT
Source type
Peer-reviewed study
Status
Published
System type
Human clinical
DOI
10.1056/nejmoa1602003
Catalogue ID
BFmokjo9ap-zknldh

Topic tags

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