Surgery for ischemic mitral regurgitation

摘要

Defining the appropriate management of mitral regurgitation secondary to ischemic heart disease - as opposed to primary disease such as rheumatic or myxomatous degeneration - has proved elusive. Coronary artery disease is common, and so is associated mitral regurgitation, at least to some degree. The latter has been recognized as an unfavorable prognostic sign for more than 25 years and thus has been a target of surgical interest, with the goal of negating the adverse effects on late survival without paying too much of an up-front cost in terms of perioperative mortality. When the regurgitation is severe, debate has centered on the role of mitral-valve repair versus replacement, as recently addressed in the Journal by Acker and colleagues. When the regurgitation is only moderate, however, the question has been whether coronary revascularization alone will suffice or whether intervention on the valve is required. Smith and colleagues now report in the Journal the results of a randomized trial comparing coronary-artery bypass grafting (CABG) alone with CABG plus mitral-valve annuloplasty.