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Differential Impact of Mitral Valve Repair on Outcome of Coronary Artery Bypass Grafting With or Without Surgical Ventricular Reconstruction in the Surgical Treatment for Ischemic Heart Failure (STICH) Trial.


ABSTRACT: Background:This study examined the impact of mitral valve repair (MVRe) on survival of patients with moderate or severe (?2+) MR and ischemic cardiomyopathy randomized to coronary artery bypass grafting (CABG) versus CABG+surgical ventricular reconstruction (SVR) in the STICH trial. Methods:Among patients with moderate or severe MR and ischemic cardiomyopathy undergoing CABG or CABG+SVR, the impact of MVRe on mortality between the two treatment arms was compared. Results:Among 867 patients with assessment of baseline MR severity, 211 had moderate or severe MR. After excluding 7 patients who underwent mitral valve replacement, 50, 44, 62, and 48 patients underwent CABG, CABG+MVRe, CABG+SVR, and CABG+SVR+MVRe, respectively. Four-year mortality rates were lower following CABG+MVRe than CABG alone (16% vs. 55%; adjusted hazard ratio [HR] 0.30; 95% CI 0.13-0.71). In contrast, the CABG+SVR+MVRe and CABG+SVR groups had similar 4-year mortality of 39% vs. 39% (adjusted HR 0.88; 95% CI 0.46-1.70). MVRe had a more favorable effect on survival in patients undergoing CABG alone compared to CABG+SVR (p=0.013). Baseline MR severity was similar between patients that received CABG+MVRe and those that underwent CABG+SVR+MVRe. A larger proportion of patients demonstrated a reduction in MR between 4 and 24 months after CABG+MVRe compared to CABG+SVR+MVRe (50.0% versus 25.0%, p=0.023). Conclusion:In patients with moderate or severe MR and ischemic cardiomyopathy undergoing CABG, MVRe appears to have a favorable effect on survival. The addition of SVR to CABG may attenuate the anticipated benefits of MVRe by limiting the long-term reduction of MR with MVRe.

SUBMITTER: Tsang MYC 

PROVIDER: S-EPMC7518414 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Differential Impact of Mitral Valve Repair on Outcome of Coronary Artery Bypass Grafting With or Without Surgical Ventricular Reconstruction in the Surgical Treatment for Ischemic Heart Failure (STICH) Trial.

Tsang Michael Y C MYC   She Lilin L   Miller Fletcher A FA   Choi Jin-Oh JO   Michler Robert E RE   Grayburn Paul A PA   Bonow Robert O RO   Menicanti Lorenzo L   Deja Marek A MA   Castelvecchio Serenella S   Rao Vivek V   Smith Peter K PK   Kukulski Tomasz T   Sopko George G   Prior David L DL   Velazquez Eric J EJ   Lee Kerry L KL   Oh Jae K JK  

Structural heart : the journal of the Heart Team 20190523 4


<h4>Background</h4>This study examined the impact of mitral valve repair (MVRe) on survival of patients with moderate or severe (≥2+) MR and ischemic cardiomyopathy randomized to coronary artery bypass grafting (CABG) versus CABG+surgical ventricular reconstruction (SVR) in the STICH trial.<h4>Methods</h4>Among patients with moderate or severe MR and ischemic cardiomyopathy undergoing CABG or CABG+SVR, the impact of MVRe on mortality between the two treatment arms was compared.<h4>Results</h4>Am  ...[more]

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