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Immediate and remote outcomes of surgical treatment for moderate ischemic mitral regurgitation in the TIME study

Chernyavsky A. M.1, Ruzmatov T. M.1, Efendiev V. U.1, Sakovich V. A.2, Podsosnikova T. N.1, Volokitina T. L.1, Batrynak A. A.3, Morozan V.3, Nesmachny A. S.1
1 – Federal State Budgetary Institution, “Academician E. N. Meshalkin Novosibirsk Research Institute of Circulatory Pathology” of the RF Ministry of Health Care, Rechkunovskaya 15, Novosibirsk 630055
2 – Federal State Budgetary Institution. “Federal Center of Cardiovascular Surgery” of the RF Ministry of Health Care, Karaulnaya 45, Krasnoyarsk 660020
3 – State Medical and Sanitary Institution, Ïstitute of Cardiology”, N. Testemitsan 29/1, Kishinev MD2025, Republic of Moldova

Keywords: ischemic mitral insufficiency, myocardial infarction, surgical methods of correction, coronary bypass surgery, coronary heart disease

DOI: 10.18087/rhj.2015.6.2106

Background. Treatment of moderate ischemic mitral regurgitation (IMR) is still a subject of debate. Aim. To compare immediate and remote outcomes of different surgical treatments for IHD complicated with moderate IMR. Materials and methods. Between May, 2011 through December, 2014, 120 patients underwent a surgery as a part of the multicenter, randomized study, Surgical Treatment of Ischemic Mitral rEgurgitation (TIME). 60 patients underwent isolated coronary bypass (CB) and 60 patients – CB with mitral valve annuloplasty (CB+MVA). The follow-up examination was performed at 12 months after the surgery. Results. Overall one-year post-surgery death rate was 6.7 % (4 patients) in the CB group and 8.3 % (5 patients) in the CB+MVA group (р=0.62). In one year after the surgery, the degree of mitral regurgitation showed a tendency to increase in the CB group and was either absent or mild in the combination treatment group. The HF NYHA functional class and scores of the quality of life questionnaire, SF-36, were comparable in both group at one year of surgery. Conclusion. In one year after the surgery, the combination surgery of CB with mitral valve plasty did not show any advantage. Obtaining more unbiased results will require a further study and data analysis at 3 and 5 years after the surgical treatment.
  1. Бокерия Л. А., Гудкова Р. Г. Сердечно-сосудистая хирургия – 2011. Болезни и врожденные аномалии системы кровообращения. – М.: НЦ ССХ им. А. Н. Бакулева РАМН, 2012. –196с.
  2. Bursi F, Enriquez-Sarano M, Nkomo VT, Jacobsen SJ, Weston SA, Meverden RA, Roger VL. Heart failure and death after myocardial infarction in the community the emerging role of mitral regurgitation. Circulation. 2005 Jan 25;111 (3):295–301.
  3. Perez de Isla L, Zamorano J, Quezada M, Almeria C, Rodrigo JL, Serra V et al. Functional mitral regurgitation after a first non-ST-segment elevation acute coronary syndrome: contribution to congestive heart failure. Eur Heart J. 2007 Dec;28 (23):2866–72.
  4. Bouma W, van der Horst IC, Wijdh-den Hamer IJ, Erasmus ME, Zijlstra F, Mariani MA, Ebels T. Chronic ischaemic mitral regurgitation. Current treatment results and new mechanism-based surgical approaches. Eur J Cardiothorac Surg. 2010 Jan;37 (1):170–85.
  5. Koelling TM, Aaronson KD, Cody RJ, Bach DS, Armstrong WF. Prognostic significance of mitral regurgitation and tricuspid regurgitation in patients with left ventricular systolic dysfunction. Am Heart J. 2002 Sep;144 (3):524–9.
  6. Ellis SG, Whitlow PL, Raymond RE, Schneider JP. Impact of mitral regurgitation on long-term survival after percutaneous coronary intervention. Am J Cardiol. 2002 Feb;89 (3):315–8.
  7. Enriquez-Sarano M. Timing of mitral valve surgery. Heart. 2002 Jan;87 (1):79–85.
  8. Gillinov AM, Wierup PN, Blackstone EH, Bishay ES, Cosgrove DM, White J et al. Is repair preferable to replacement for ischemic mitral regurgitation? J Thorac Cardiovasc Surg. 2001 Dec;122 (6):1125–41.
  9. Miller DC. Ischemic mitral regurgitation redux – to repair or to replace? J Thorac Cardiovasc Surg. 2001 Dec;122 (6):1059–62.
  10. Kang DH, Kim MJ, Kang SJ, Song JM, Song H, Hong MK et al. Mitral valve repair versus revascularization alone in the treatment of ischemic mitral regurgitation. Circulation. 2006 Jul 4;114 (1 Suppl): I499–503.
  11. Fattouch K, Guccione F, Sampognaro R, Panzarella G, Corrado E, Navarra E et al. POINT: Efficacy of adding mitral valve restrictive annuloplasty to CABG in patients with moderate ischemic mitral valve regurgitation: a randomized trial. J Thorac Cardiovasc Surg. 2009 Aug;138 (2):278–85.
  12. Chan KM, Punjabi PP, Flather M, Wage R, Symmonds K, Roussin I et al. Coronary artery bypass surgery with or without mitral valve annuloplasty in moderate functional ischemic mitral regurgitation: final results of the Randomized Ischemic Mitral Evaluation (RIME) Trial. Circulation. 2012 Nov 20;126 (21):2502–10.
  13. Smith PK, Puskas JD, Ascheim DD, Voisine P, Gelijns AC, Moskowitz AJ et al. Surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med. 2014 Dec 4;371 (23):2178–88.
  14. Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr. 2010 May;11 (4):307–32.
  15. Bax JJ, Braun J, Somer ST, Klautz R, Holman ER, Versteegh MI et al. Restrictive annuloplasty and coronary revascularization in ische­mic mitral regurgitation results in reverse left ventricular remode­ling. Circulation. 2004 Sep 14;110 (11 Suppl 1):II103–8.
  16. Aklog L, Filsoufi F, Flores KQ, Chen RH, Cohn LH, Nathan NS et al. Does coronary artery bypass grafting alone correct mode­rate ischemic mitral regurgitation? Circulation. 2001 Sep 18;104 (12 Suppl 1):I68–75.
  17. Deja MA, Grayburn PA, Sun B, Rao V, She L, Krejca M et al. Influence of mitral regurgitation repair on survival in the surgical treatment for ischemic heart failure trial. Circulation. 2012 May 29;125 (21):2639–48.
  18. Чернявский А. М., Эфендиев В. У., Рузматов Т. М. Пластика митрального клапана и изолированное коронарное шунтирование при ишемической кардиомиопатии и умеренной митральной недостаточности. Патология кровообращения и кардиохирургия. 2015;1:15–20.
  19. Castleberry AW, Williams JB, Daneshmand MA, Honeycutt E, Shaw LK, Samad Z et al. Surgical revascularization is associated with maximal survival in patients with ischemic mitral regurgitation: a 20‑year experience. Circulation. 2014 Jun 17;129 (24):2547–56.
  20. Milano CA, Daneshmand MA, Rankin JS, Honeycutt E, Williams ML, Swaminathan M et al. Survival prognosis and surgical mana­gement of ischemic mitral regurgitation. Ann Thorac Surg. 2008 Sep;86 (3):735–44.
  21. Rydén T, Bech-Hanssen O, Brandrup-Wognsen G, Nilsson F, Svensson S, Jeppsson A. The importance of grade 2 ischemic mitral regurgitation in coronary artery bypass grafting. Eur J Cardiothorac Surg. 2001 Aug;20 (2):276–81.
  22. Wong DR, Agnihotri AK, Hung JW, Vlahakes GJ, Akins CW, Hilgenberg AD et al. Long-term survival after surgical revasculari­zation for moderate ischemic mitral regurgitation. Ann Thorac Surg. 2005 Aug;80 (2):570–7.
  23. Kim YH, Czer LS, Soukiasian HJ, De Robertis M, Magliato KE, Blanche C et al. Ischemic mitral regurgitation: revascularization alone versus revascularization and mitral valve repair. Ann Thorac Surg. 2005 Jun;79 (6):1895–901.
  24. Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al. 2011 ACCF / AHA guideline for coronary artery bypass graft surgery: a report of the American College of Cardiology Foundation / American Heart Association task force on practice guidelines developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2011 Dec 6;58 (24):e123–210.
  25. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA et al. 2014 AHA / ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology / American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Jun 10;63 (22):e57–185.
  26. Mihaljevic T, Lam BK, Rajeswaran J, Takagaki M, Lauer MS, Gillinov AM et al. Impact of mitral valve annuloplasty combined with revascularization in patients with functional ischemic mitral regurgitation. J Am Coll Cardiol. 2007 Jun 5;49 (22):2191–201.
Chernyavsky A. M., Ruzmatov T. M., Efendiev V. U., Sakovich V. A., Podsosnikova T. N., Volokitina T. L. et al. Immediate and remote outcomes of surgical treatment for moderate ischemic mitral regurgitation in the TIME study. Russian Heart Journal. 2015;14 (6):383–388

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