Ischemic Mitral Regurgitation: Revascularization Alone Versus Revascularization and Mitral Valve Repair Yong-Hwan Kim, MD, PhD, Lawrence S.C. Czer, MD,

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Ischemic Mitral Regurgitation: Revascularization Alone Versus Revascularization and Mitral Valve Repair Yong-Hwan Kim, MD, PhD, Lawrence S.C. Czer, MD, Harmik J. Soukiasian, MD, Michele De Robertis, RN, Kathy E. Magliato, MD, Carlos Blanche, MD, Sharo S. Raissi, MD, James Mirocha, MS, Robert J. Siegel, MD, Robert M. Kass, MD, Alfredo Trento, MD The Annals of Thoracic Surgery Volume 79, Issue 6, Pages 1895-1901 (June 2005) DOI: 10.1016/j.athoracsur.2004.11.005 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Preoperative to postoperative change in grade of mitral regurgitation. A greater change in mitral regurgitation grade was found after combined revascularization and mitral valve repair than after revascularization alone (2.7 ± 0.1 grades versus 0.2 ± 0.1 grade, p < 0.001). (CABG = coronary artery bypass grafting; MR = mitral regurgitation; MV = mitral valve.) The Annals of Thoracic Surgery 2005 79, 1895-1901DOI: (10.1016/j.athoracsur.2004.11.005) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Success rates for reduction of mitral regurgitation by two or more grades. Success rates were 11% after revascularization alone (n = 168), 94% after Carpentier-Edwards ring annuloplasty (n = 70), 86% after Dacron ring annuloplasty (n = 36), 73% after pericardial ring annuloplasty (n = 26), 94% after other types of ring annuloplasty (n = 48), and 86% after suture annuloplasty (n = 7). Overall, the success rate after combined mitral valve repair and revascularization was 89% (167/187; p < 0.001 in comparison with revascularization alone). When comparing different valve repair types, the pericardial ring had a significantly lower success rate than the Carpentier-Edwards (classic) ring. (CE = Carpentier-Edwards.) The Annals of Thoracic Surgery 2005 79, 1895-1901DOI: (10.1016/j.athoracsur.2004.11.005) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Postoperative survival after revascularization alone (- - - - - -), or after combined revascularization and mitral valve repair (———). Survival rates in the respective groups were 96% ± 2% and 89% ± 2% at 30 days; 80% ± 3% and 77% ± 3% at 1 year; 64% ± 4% and 66% ± 4% at 3 years; and 52% ± 5% and 44% ± 5% at 5 years (mean ± standard error; p = 0.30). The Annals of Thoracic Surgery 2005 79, 1895-1901DOI: (10.1016/j.athoracsur.2004.11.005) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Postoperative survival after revascularization alone (- - - - - -) or after combined revascularization and mitral valve repair (———) in patients with 3+ or 4+ mitral regurgitation (MR) before the operation. After the first postoperative year the combined group had higher survival, but overall survival was not significantly different (p = 0.53). The Annals of Thoracic Surgery 2005 79, 1895-1901DOI: (10.1016/j.athoracsur.2004.11.005) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions