Off Pump Coronary Artery Bypass versus Mitral Annuloplasty in Moderate Ischemic Mitral Regurgitation

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Purpose: To compare the outcomes of isolated off-pump coronary artery bypass grafting (OPCAB) to those of mitral annuloplasty (MAP) with revascularization in patients with moderate ischemic mitral regurgitation (MR).Methods: Between April 2001 and December 2009, 140 patients with moderate ischemic MR who underwent isolated OPCAB (OPCAB group, n = 77) or MAP with revascularization (MAP group, n = 63) were analyzed.Results: Freedom from cardiac-related death at eight years was similar between groups (78.4 ± 5.5%, the OPCAB group versus 81.5 ± 5.9%, the MAP group, p = 0.297). In patients with left ventricular ejection fraction (LVEF) >40%, the MAP group were similar to the OPCAB group in freedom from recurrent MR at eight years (85.7± 10.0% versus 84.9 ± 8.3%, p = 0.738), but a significant difference was found in patients with LVEF ≤40% (93.5± 4.5%, the MAP group versus 36.9 ± 18.4%, the OPCAB group, p = 0.013). On multivariate analysis, emergency operation and low LVEF were predictive of recurrent MR.Conclusion: Concomitant MAP was more effective against recurrent MR than was OPCAB alone, in patients with LVEF ≤40%. We suggest that MAP should be considered in moderate ischemic MR with low LVEF.
2012-08-01