Findings on Valve Repair During CABG

Patients with moderate ischemic mitral regurgitation (IMR) who are referred for coronary artery bypass graft (CABG) may not need an additional, common procedure.

Mitral valve repair (MVr) is often performed at the same time as CABG for IMR patients, but results from a randomized study released as a late-breaking trial at the AHA Scientific Sessions last week showed that the routine addition of MVr may not be warranted, at least by the 1-year postsurgical mark.

Researchers randomly assigned 301 patients with moderate IMR to groups that had CABG alone or CABG with MVr. The primary endpoint of the study was left ventricular end systolic volume index (LVESVI) at 1-year after surgery.

The researchers found that both CABG and CABG+MVr patients had significant improvement in LVESVI at 1 year but did not differ in the degree of improvement. There were a significantly increased number of neurologic events in the MVr group, but less residual MR. CABG alone resulted in 70% of the patients having no, trace, or mild residual MR at 1 year. Importantly, there were no differences between the groups in terms of mortality, major adverse cardiac and cerebrovascular events, readmissions, or quality of life.

Lead study author Peter K. Smith, MD, division chief for cardiothoracic surgery at Duke, says that the conclusion about beneficial omission of MVr held to the 1-year mark, but follow-up is required. Study follow-up will continue for 24 months to learn whether MR improvement lasts and to further judge clinical outcomes for the two groups.