Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation?

Background-The optimal management of moderate (3+ on a scale of 0 to 4+) is chemic mitral regurgitation (MR) remains controversial. Some advocate CABG alone, whereas others favor concomitant mitral annuloplasty. To clarify the optimal management of these patients, we evaluated the early impact of iso lated CABG on moderate ischemic MR. Methods and Results-Between January 1992 and August 1999, 136 patients (54% male, mean age 70.5 years. mean New York Heart Association class 2.7, mean ejection fraction 38.1%) with a preoperative diagnosis of moderate ischemi c MR, without leaflet prolapse or pathology, underwent isolated CABG. Thirt y-eight (28%) of 136 patients had intraoperative transesophageal echocardio graphy (TEE) before CABG, and 68 (50%) had postoperative transthoracic echo cardiography (TTE) within 6 weeks of surgery. The subgroups of patients und ergoing intraoperative TEE and postoperative TTE had preoperative character istics similar to the overall group. The 30-day operative mortality was 2.9 % (4/136). Intraoperative TEE downgraded the severity of MR to mild or less (0 to 2+) in 89% (34/38). On postoperative TTE, 40% (27/68) continued to h ave at least moderate MR (3 to 4+), 51% (35/68) improved somewhat to mild ( 2+) MR, and only 9% (6/68) had resolution of their MR (0 to 1+). The mean p reoperative, intraoperative, and postoperative MR grades were 3.0 +/-0.0, 1 .4 +/-1.0, and 2.3 +/-0.8, respectively (P <0.001). Conclusions-CABG alone for moderate ischemic MR leaves many patients with s ignificant residual MR and may not be the optimal therapy for most patients . Intraoperative TEE may significantly underestimate the severity of ischem ic MR. A preoperative diagnosis of moderate MR may warrant concomitant mitr al annuloplasty.