10-Year Results of Mitral Repair and Coronary Bypass for Ischemic Regurgitation: A Randomized Trial
| Autor: | Francesco Guccione, Roberta Sampognaro, Pietro Dioguardi, Angela Nogara, Massimo Salardino, Khalil Fattouch, Marco Moscarelli, Daniela Bacarella |
|---|---|
| Rok vydání: | 2022 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Mitral Valve Annuloplasty New York Heart Association Class Myocardial Ischemia law.invention Coronary artery bypass surgery Randomized controlled trial law Internal medicine Mitral valve annuloplasty medicine Humans Prospective Studies Coronary Artery Bypass Ejection fraction Ventricular Remodeling business.industry Mitral Valve Insufficiency Confidence interval Treatment Outcome medicine.anatomical_structure Bypass surgery Ventricle Cardiology Mitral Valve Surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of Thoracic Surgery. 113:816-822 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2021.03.106 |
| Popis: | The decision to treat moderate ischemic mitral regurgitation (IMR) at the time of coronary artery bypass surgery (CABG) remains controversial. We previously conducted a prospective randomized trial that showed a benefit of adding restricted annuloplasty to bypass surgery (CABG-Ring group) in terms of IMR grade, New York Heart Association classification, and left ventricle reverse remodeling. Here, we present the long-term (10 years) follow-up data from this randomized trial.The original trial arms accounted for 54 patients in the CABG-alone and 48 in the CABG-Ring group; patients were re-contacted for follow-up to obtain relevant clinical and echocardiographic information.The mean follow-up was 160.4 ± 45.5 months. Survival probabilities in the CABG-alone and CABG-Ring groups were 96% vs 93% at 3 years, 85% vs 89% at 6 years, 79% vs 85% at 9 years, 77% vs 83% at 12 years, and 72% vs 80% at 15 years, respectively (P = .18) Freedom from at least moderate IMR or reintervention at last follow-up was also higher in the CABG-Ring group (P.001). Compared with the CABG-alone group, the CABG-Ring group had a higher degree of left ventricular reverse remodeling (54.7 ± 6.9 mm vs 51.6 ± 6 mm, respectively; P = .03), lower New York Heart Association class (P.001), and a lower rate of rehospitalization (P = .002).Long-term follow-up data from our randomized trial further support the utility of performing restricted annuloplasty at the time of CABG to prevent further progression of IMR, mitral reintervention, and left ventricle remodeling. Untreated IMR was associated with significantly higher New York Heart Association class and rehospitalization. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|