Percutaneous Versus Surgical Revascularization in Patients With Ischemic Mitral Regurgitation
- 13 September 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 124 (11_suppl_1), S156-62
- https://doi.org/10.1161/circulationaha.110.011254
Abstract
Background—: The proper way of revascularization remains controversial in patients with ischemic mitral regurgitation (IMR). We sought to compare the long-term results of percutaneous coronary intervention (PCI) and surgical revascularization in IMR. Methods and Results—: From 1996 to 2008, 185 consecutive patients (132 men; age, 63±9 years) with significant IMR underwent PCI (PCI group) (n=66) or coronary artery bypass graft surgery (OP group) (n=119). In the OP group, 68 (57%) patients also underwent concomitant mitral annuloplasty. Significant IMR was defined as functional MR occurring >1 week after myocardial infarction with an effective regurgitant orifice area ≥0.2 cm 2 . During a median follow-up of 54 months, there were 2 operative mortalities, 26 cardiac deaths, and 11 heart failure hospitalizations in the OP group and 22 cardiac deaths and 10 heart failure hospitalizations in the PCI group. The survival and cardiac mortality rates were not significantly different between the 2 groups, but event-free survival rates were significantly higher in the OP group. For the 45 propensity score-matched pairs, the risk of cardiac events was significantly lower in the OP group than in the PCI group (hazard ratio, 0.499; 95% CI, 0.251 to 0.990; P =0.043). Compared with patients who underwent coronary artery bypass graft surgery alone, event-free survival rates were significantly higher in those who underwent additional mitral annuloplasty. Conclusions—: Compared with PCI, surgical revascularization is associated with an improved long-term event-free survival, and concomitant mitral annuloplasty should be considered in patients with significant IMR.This publication has 23 references indexed in Scilit:
- Predictors of Improvement of Unrepaired Moderate Ischemic Mitral Regurgitation in Patients Undergoing Elective Isolated Coronary Artery Bypass Graft SurgeryCirculation, 2009
- Surgical Management of Ischemic Mitral RegurgitationCirculation, 2009
- Have We Found the Surgical Solution for Ischemic Mitral Regurgitation?Circulation, 2009
- Long-Term Mortality After Percutaneous Coronary Intervention With Drug-Eluting Stent Implantation Versus Coronary Artery Bypass Surgery for the Treatment of Multivessel Coronary Artery DiseaseCirculation, 2008
- Five-year echocardiographic results of combined undersized mitral ring annuloplasty and coronary artery bypass grafting for chronic ischaemic mitral regurgitationEuropean Heart Journal, 2007
- Mitral Valve Repair Versus Revascularization Alone in the Treatment of Ischemic Mitral RegurgitationCirculation, 2006
- Long-Term Survival After Surgical Revascularization for Moderate Ischemic Mitral RegurgitationThe Annals of Thoracic Surgery, 2005
- Quantitative Determinants of the Outcome of Asymptomatic Mitral RegurgitationThe New England Journal of Medicine, 2005
- Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunctionJournal of the American College of Cardiology, 2005
- ACC/AHA 2004 Guideline Update for Coronary Artery Bypass Graft Surgery: Summary ArticleCirculation, 2004