Influence of mitral regurgitation repair on survival in the surgical treatment for ischemic heart failure trial

Marek A. Deja, Paul A. Grayburn, Benjamin Sun, Vivek Rao, Lilin She, Michał Krejca, Anil R. Jain, Yeow Chua Leng, Richard Daly, Michele Senni, Krzysztof Mokrzycki, Lorenzo Menicanti, Jae K. Oh, Robert E. Michler, Krzysztof Wróbel, Andre Lamy, Eric J. Velazquez, Kerry L. Lee, Robert H. Jones

Research output: Contribution to journalArticle

121 Citations (Scopus)

Abstract

Background-Whether mitral valve repair during coronary artery bypass grafting (CABG) improves survival in patients with ischemic mitral regurgitation (MR) remains unknown. Methods and Results-Patients with ejection fraction ≤35% and coronary artery disease amenable to CABG were randomized at 99 sites worldwide to medical therapy with or without CABG. The decision to treat the mitral valve during CABG was left to the surgeon. The primary end point was mortality. Of 1212 randomized patients, 435 (36%) had none/trace MR, 554 (46%) had mild MR, 181 (15%) had moderate MR, and 39 (3%) had severe MR. In the medical arm, 70 deaths (32%) occurred in patients with none/trace MR, 114 (44%) in those with mild MR, and 58 (50%) in those with moderate to severe MR. In patients with moderate to severe MR, there were 29 deaths (53%) among 55 patients randomized to CABG who did not receive mitral surgery (hazard ratio versus medical therapy, 1.20; 95% confidence interval, 0.77-1.87) and 21 deaths (43%) among 49 patients who received mitral surgery (hazard ratio versus medical therapy, 0.62; 95% confidence interval, 0.35-1.08). After adjustment for baseline prognostic variables, the hazard ratio for CABG with mitral surgery versus CABG alone was 0.41 (95% confidence interval, 0.22-0.77; P=0.006). Conclusion-Although these observational data suggest that adding mitral valve repair to CABG in patients with left ventricular dysfunction and moderate to severe MR may improve survival compared with CABG alone or medical therapy alone, a prospective randomized trial is necessary to confirm the validity of these observations. Clinical Trial Registration-URL: http://www.clinicaltrials. gov. Unique identifier: NCT00023595.

Original languageEnglish (US)
Pages (from-to)2639-2648
Number of pages10
JournalCirculation
Volume125
Issue number21
DOIs
StatePublished - May 29 2012

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Mitral Valve Insufficiency
Coronary Artery Bypass
Heart Failure
Survival
Mitral Valve
Therapeutics
Confidence Intervals
Left Ventricular Dysfunction
Coronary Artery Disease
Clinical Trials
Mortality

Keywords

  • cardiomyopathy
  • coronary disease
  • mitral valve
  • surgery
  • trials

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Deja, M. A., Grayburn, P. A., Sun, B., Rao, V., She, L., Krejca, M., ... Jones, R. H. (2012). Influence of mitral regurgitation repair on survival in the surgical treatment for ischemic heart failure trial. Circulation, 125(21), 2639-2648. https://doi.org/10.1161/CIRCULATIONAHA.111.072256

Influence of mitral regurgitation repair on survival in the surgical treatment for ischemic heart failure trial. / Deja, Marek A.; Grayburn, Paul A.; Sun, Benjamin; Rao, Vivek; She, Lilin; Krejca, Michał; Jain, Anil R.; Leng, Yeow Chua; Daly, Richard; Senni, Michele; Mokrzycki, Krzysztof; Menicanti, Lorenzo; Oh, Jae K.; Michler, Robert E.; Wróbel, Krzysztof; Lamy, Andre; Velazquez, Eric J.; Lee, Kerry L.; Jones, Robert H.

In: Circulation, Vol. 125, No. 21, 29.05.2012, p. 2639-2648.

Research output: Contribution to journalArticle

Deja, MA, Grayburn, PA, Sun, B, Rao, V, She, L, Krejca, M, Jain, AR, Leng, YC, Daly, R, Senni, M, Mokrzycki, K, Menicanti, L, Oh, JK, Michler, RE, Wróbel, K, Lamy, A, Velazquez, EJ, Lee, KL & Jones, RH 2012, 'Influence of mitral regurgitation repair on survival in the surgical treatment for ischemic heart failure trial', Circulation, vol. 125, no. 21, pp. 2639-2648. https://doi.org/10.1161/CIRCULATIONAHA.111.072256
Deja, Marek A. ; Grayburn, Paul A. ; Sun, Benjamin ; Rao, Vivek ; She, Lilin ; Krejca, Michał ; Jain, Anil R. ; Leng, Yeow Chua ; Daly, Richard ; Senni, Michele ; Mokrzycki, Krzysztof ; Menicanti, Lorenzo ; Oh, Jae K. ; Michler, Robert E. ; Wróbel, Krzysztof ; Lamy, Andre ; Velazquez, Eric J. ; Lee, Kerry L. ; Jones, Robert H. / Influence of mitral regurgitation repair on survival in the surgical treatment for ischemic heart failure trial. In: Circulation. 2012 ; Vol. 125, No. 21. pp. 2639-2648.
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abstract = "Background-Whether mitral valve repair during coronary artery bypass grafting (CABG) improves survival in patients with ischemic mitral regurgitation (MR) remains unknown. Methods and Results-Patients with ejection fraction ≤35{\%} and coronary artery disease amenable to CABG were randomized at 99 sites worldwide to medical therapy with or without CABG. The decision to treat the mitral valve during CABG was left to the surgeon. The primary end point was mortality. Of 1212 randomized patients, 435 (36{\%}) had none/trace MR, 554 (46{\%}) had mild MR, 181 (15{\%}) had moderate MR, and 39 (3{\%}) had severe MR. In the medical arm, 70 deaths (32{\%}) occurred in patients with none/trace MR, 114 (44{\%}) in those with mild MR, and 58 (50{\%}) in those with moderate to severe MR. In patients with moderate to severe MR, there were 29 deaths (53{\%}) among 55 patients randomized to CABG who did not receive mitral surgery (hazard ratio versus medical therapy, 1.20; 95{\%} confidence interval, 0.77-1.87) and 21 deaths (43{\%}) among 49 patients who received mitral surgery (hazard ratio versus medical therapy, 0.62; 95{\%} confidence interval, 0.35-1.08). After adjustment for baseline prognostic variables, the hazard ratio for CABG with mitral surgery versus CABG alone was 0.41 (95{\%} confidence interval, 0.22-0.77; P=0.006). Conclusion-Although these observational data suggest that adding mitral valve repair to CABG in patients with left ventricular dysfunction and moderate to severe MR may improve survival compared with CABG alone or medical therapy alone, a prospective randomized trial is necessary to confirm the validity of these observations. Clinical Trial Registration-URL: http://www.clinicaltrials. gov. Unique identifier: NCT00023595.",
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T1 - Influence of mitral regurgitation repair on survival in the surgical treatment for ischemic heart failure trial

AU - Deja, Marek A.

AU - Grayburn, Paul A.

AU - Sun, Benjamin

AU - Rao, Vivek

AU - She, Lilin

AU - Krejca, Michał

AU - Jain, Anil R.

AU - Leng, Yeow Chua

AU - Daly, Richard

AU - Senni, Michele

AU - Mokrzycki, Krzysztof

AU - Menicanti, Lorenzo

AU - Oh, Jae K.

AU - Michler, Robert E.

AU - Wróbel, Krzysztof

AU - Lamy, Andre

AU - Velazquez, Eric J.

AU - Lee, Kerry L.

AU - Jones, Robert H.

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N2 - Background-Whether mitral valve repair during coronary artery bypass grafting (CABG) improves survival in patients with ischemic mitral regurgitation (MR) remains unknown. Methods and Results-Patients with ejection fraction ≤35% and coronary artery disease amenable to CABG were randomized at 99 sites worldwide to medical therapy with or without CABG. The decision to treat the mitral valve during CABG was left to the surgeon. The primary end point was mortality. Of 1212 randomized patients, 435 (36%) had none/trace MR, 554 (46%) had mild MR, 181 (15%) had moderate MR, and 39 (3%) had severe MR. In the medical arm, 70 deaths (32%) occurred in patients with none/trace MR, 114 (44%) in those with mild MR, and 58 (50%) in those with moderate to severe MR. In patients with moderate to severe MR, there were 29 deaths (53%) among 55 patients randomized to CABG who did not receive mitral surgery (hazard ratio versus medical therapy, 1.20; 95% confidence interval, 0.77-1.87) and 21 deaths (43%) among 49 patients who received mitral surgery (hazard ratio versus medical therapy, 0.62; 95% confidence interval, 0.35-1.08). After adjustment for baseline prognostic variables, the hazard ratio for CABG with mitral surgery versus CABG alone was 0.41 (95% confidence interval, 0.22-0.77; P=0.006). Conclusion-Although these observational data suggest that adding mitral valve repair to CABG in patients with left ventricular dysfunction and moderate to severe MR may improve survival compared with CABG alone or medical therapy alone, a prospective randomized trial is necessary to confirm the validity of these observations. Clinical Trial Registration-URL: http://www.clinicaltrials. gov. Unique identifier: NCT00023595.

AB - Background-Whether mitral valve repair during coronary artery bypass grafting (CABG) improves survival in patients with ischemic mitral regurgitation (MR) remains unknown. Methods and Results-Patients with ejection fraction ≤35% and coronary artery disease amenable to CABG were randomized at 99 sites worldwide to medical therapy with or without CABG. The decision to treat the mitral valve during CABG was left to the surgeon. The primary end point was mortality. Of 1212 randomized patients, 435 (36%) had none/trace MR, 554 (46%) had mild MR, 181 (15%) had moderate MR, and 39 (3%) had severe MR. In the medical arm, 70 deaths (32%) occurred in patients with none/trace MR, 114 (44%) in those with mild MR, and 58 (50%) in those with moderate to severe MR. In patients with moderate to severe MR, there were 29 deaths (53%) among 55 patients randomized to CABG who did not receive mitral surgery (hazard ratio versus medical therapy, 1.20; 95% confidence interval, 0.77-1.87) and 21 deaths (43%) among 49 patients who received mitral surgery (hazard ratio versus medical therapy, 0.62; 95% confidence interval, 0.35-1.08). After adjustment for baseline prognostic variables, the hazard ratio for CABG with mitral surgery versus CABG alone was 0.41 (95% confidence interval, 0.22-0.77; P=0.006). Conclusion-Although these observational data suggest that adding mitral valve repair to CABG in patients with left ventricular dysfunction and moderate to severe MR may improve survival compared with CABG alone or medical therapy alone, a prospective randomized trial is necessary to confirm the validity of these observations. Clinical Trial Registration-URL: http://www.clinicaltrials. gov. Unique identifier: NCT00023595.

KW - cardiomyopathy

KW - coronary disease

KW - mitral valve

KW - surgery

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