Mitral repair for moderate ischemic mitral regurgitation in patients with end-stage ischemic cardiomyopathy.
- 1Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine, Osaka, Japan.
Abstract
Objectives
For patients with end-stage ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG), the indications for concomitant repair of moderate mitral regurgitation (MR) remain controversial. This study evaluated outcomes of concomitant mitral valve repair (MVr) for moderate ischemic MR in patients with advanced left ventricular (LV) remodeling and severely impaired LV function undergoing CABG.Methods
We retrospectively reviewed 341 patients (mean age, 67 ± 9 years) with ischemic cardiomyopathy (LV ejection fraction, ≤40%) and less-than-severe MR who underwent CABG. Of these, 108 (32%) underwent concomitant MVr for clinically relevant moderate MR, and 233 (68%) underwent CABG alone for mild or absent MR. All patients had a prior myocardial infarction. The primary end point was overall survival. Secondary end points included postoperative changes in MR grade and LV function at 1 year. Median follow-up was 4.5 years (interquartile range, 2.4-7.3 years).Results
Despite higher preoperative surgical risk in the CABG + MVr group (European System for Cardiac Operative Risk Evaluation II score, 6.7% vs 2.9%; P < .001), 30-day mortality did not differ between groups (1.9% vs 2.1%; P = .88). Five-year overall survival was 73% versus 77% (log-rank P = .25). At 1 year, the CABG + MVr group demonstrated greater LV reverse remodeling (median LV end-diastolic volume index reduction: -26% vs -19%; P = .001), higher LV ejection fraction (46 ± 13% vs 42 ± 12%; P = .044), and a lower prevalence of significant MR (6% vs 13%; P = .032).Conclusions
In patients with advanced ischemic cardiomyopathy and moderate MR, concomitant MVr can be performed with acceptable operative risk and promotes superior LV reverse remodeling. Long-term survival was comparable to patients with nonsignificant MR who did not require mitral intervention, suggesting that targeted mitral repair may normalize the adverse prognostic influence of moderate ischemic MR.
Related
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BibTeX
@article{misumi2026mitral,
title = {{Mitral repair for moderate ischemic mitral regurgitation in patients with end-stage ischemic cardiomyopathy.}},
author = {Yusuke Misumi and Daisuke Yoshioka and Shin Yajima and Takuji Kawamura and Ai Kawamura and Kazuma Handa and Akinobu Ohtani and Shunsuke Saito and Kazuo Shimamura and Shigeru Miyagawa},
journal = {JTCVS open},
year = {2026},
month = jul,
doi = {10.1016/j.xjon.2026.101963},
url = {https://europepmc.org/article/MED/42948419},
note = {CC BY},
}
RIS
TY - JOUR
TI - Mitral repair for moderate ischemic mitral regurgitation in patients with end-stage ischemic cardiomyopathy.
AU - Yusuke Misumi
AU - Daisuke Yoshioka
AU - Shin Yajima
AU - Takuji Kawamura
AU - Ai Kawamura
AU - Kazuma Handa
AU - Akinobu Ohtani
AU - Shunsuke Saito
AU - Kazuo Shimamura
AU - Shigeru Miyagawa
PY - 2026
DA - 2026/07/10
JO - JTCVS open
DO - 10.1016/j.xjon.2026.101963
UR - https://europepmc.org/article/MED/42948419
AB - Objectives For patients with end-stage ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG), the indications for concomitant repair of moderate mitral regurgitation (MR) remain controversial. This study evaluated outcomes of concomitant mitral valve repair (MVr) for moderate ischemic MR in patients with advanced left ventricular (LV) remodeling and severely impaired LV function undergoing CABG.Methods We retrospectively reviewed 341 patients (mean age, 67 ± 9 years) with ischemic cardiomyopathy (LV ejection fraction, ≤40%) and less-than-severe MR who underwent CABG. Of these, 108 (32%) underwent concomitant MVr for clinically relevant moderate MR, and 233 (68%) underwent CABG alone for mild or absent MR. All patients had a prior myocardial infarction. The primary end point was overall survival. Secondary end points included postoperative changes in MR grade and LV function at 1 year. Median follow-up was 4.5 years (interquartile range, 2.4-7.3 years).Results Despite higher preoperative surgical risk in the CABG + MVr group (European System for Cardiac Operative Risk Evaluation II score, 6.7% vs 2.9%; P < .001), 30-day mortality did not differ between groups (1.9% vs 2.1%; P = .88). Five-year overall survival was 73% versus 77% (log-rank P = .25). At 1 year, the CABG + MVr group demonstrated greater LV reverse remodeling (median LV end-diastolic volume index reduction: -26% vs -19%; P = .001), higher LV ejection fraction (46 ± 13% vs 42 ± 12%; P = .044), and a lower prevalence of significant MR (6% vs 13%; P = .032).Conclusions In patients with advanced ischemic cardiomyopathy and moderate MR, concomitant MVr can be performed with acceptable operative risk and promotes superior LV reverse remodeling. Long-term survival was comparable to patients with nonsignificant MR who did not require mitral intervention, suggesting that targeted mitral repair may normalize the adverse prognostic influence of moderate ischemic MR.
SN - 2666-2736
ER -