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Tsang MYC, She L, Miller FA, et al. Differential Impact of Mitral Valve Repair on Outcome of Coronary Artery Bypass Grafting With or Without Surgical Ventricular Reconstruction in the Surgical Treatment for Ischemic Heart Failure (STICH) Trial. Struct Heart. 2019;3(4):302-308doi: 10.1080/24748706.2019.1610201.
Tsang, M. Y. C., She, L., Miller, F. A., Choi, J. O., Michler, R. E., Grayburn, P. A., Bonow, R. O., Menicanti, L., Deja, M. A., Castelvecchio, S., Rao, V., Smith, P. K., Kukulski, T., Sopko, G., Prior, D. L., Velazquez, E. J., Lee, K. L., & Oh, J. K. (2019). Differential Impact of Mitral Valve Repair on Outcome of Coronary Artery Bypass Grafting With or Without Surgical Ventricular Reconstruction in the Surgical Treatment for Ischemic Heart Failure (STICH) Trial. Structural heart : the journal of the Heart Team, 3(4), 302-308. https://doi.org/10.1080/24748706.2019.1610201
Tsang, Michael Y C, et al. "Differential Impact of Mitral Valve Repair on Outcome of Coronary Artery Bypass Grafting With or Without Surgical Ventricular Reconstruction in the Surgical Treatment for Ischemic Heart Failure (STICH) Trial." Structural heart : the journal of the Heart Team vol. 3,4 (2019): 302-308. doi: https://doi.org/10.1080/24748706.2019.1610201
Tsang MYC, She L, Miller FA, Choi JO, Michler RE, Grayburn PA, Bonow RO, Menicanti L, Deja MA, Castelvecchio S, Rao V, Smith PK, Kukulski T, Sopko G, Prior DL, Velazquez EJ, Lee KL, Oh JK. Differential Impact of Mitral Valve Repair on Outcome of Coronary Artery Bypass Grafting With or Without Surgical Ventricular Reconstruction in the Surgical Treatment for Ischemic Heart Failure (STICH) Trial. Struct Heart. 2019;3(4):302-308. doi: 10.1080/24748706.2019.1610201. Epub 2019 May 23. PMID: 32984753; PMCID: PMC7518414.
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Struct Heart. 2019;3(4):302-308. doi: 10.1080/24748706.2019.1610201. Epub 2019 May 23.

Differential Impact of Mitral Valve Repair on Outcome of Coronary Artery Bypass Grafting With or Without Surgical Ventricular Reconstruction in the Surgical Treatment for Ischemic Heart Failure (STICH) Trial.

Structural heart : the journal of the Heart Team

Michael Y C Tsang, Lilin She, Fletcher A Miller, Jin-Oh Choi, Robert E Michler, Paul A Grayburn, Robert O Bonow, Lorenzo Menicanti, Marek A Deja, Serenella Castelvecchio, Vivek Rao, Peter K Smith, Tomasz Kukulski, George Sopko, David L Prior, Eric J Velazquez, Kerry L Lee, Jae K Oh

Affiliations

  1. Echocardiography Core Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
  2. Division of Cardiology, Department of Medicine, University of British Columbia, BC, Canada.
  3. Duke Clinical Research Institute and Departments of Surgery (PKS), Medicine (EJV), and Biostatistics and Bioinformatics (KLL), Duke University School of Medicine, Durham, NC, USA.
  4. Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  5. Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, NY, USA.
  6. Department of Internal Medicine, Cardiology Section, Baylor University Medical Center, Dallas, TX, USA.
  7. Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
  8. IRCCS Policlinico San Donato, Milan, Italy.
  9. Medical University of Silesia, Katowice, Poland.
  10. Toronto General Hospital, Toronto, ON, Canada.
  11. Department of Cardiology, Congenital Heart Disease and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland.
  12. Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
  13. Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
  14. Section of Cardiovascular Medicine, Yale School of Medicine, Hew Haven, CT, USA.

PMID: 32984753 PMCID: PMC7518414 DOI: 10.1080/24748706.2019.1610201

Abstract

BACKGROUND: This study examined the impact of mitral valve repair (MVRe) on survival of patients with moderate or severe (≥2+) MR and ischemic cardiomyopathy randomized to coronary artery bypass grafting (CABG) versus CABG+surgical ventricular reconstruction (SVR) in the STICH trial.

METHODS: Among patients with moderate or severe MR and ischemic cardiomyopathy undergoing CABG or CABG+SVR, the impact of MVRe on mortality between the two treatment arms was compared.

RESULTS: Among 867 patients with assessment of baseline MR severity, 211 had moderate or severe MR. After excluding 7 patients who underwent mitral valve replacement, 50, 44, 62, and 48 patients underwent CABG, CABG+MVRe, CABG+SVR, and CABG+SVR+MVRe, respectively. Four-year mortality rates were lower following CABG+MVRe than CABG alone (16% vs. 55%; adjusted hazard ratio [HR] 0.30; 95% CI 0.13-0.71). In contrast, the CABG+SVR+MVRe and CABG+SVR groups had similar 4-year mortality of 39% vs. 39% (adjusted HR 0.88; 95% CI 0.46-1.70). MVRe had a more favorable effect on survival in patients undergoing CABG alone compared to CABG+SVR (

CONCLUSION: In patients with moderate or severe MR and ischemic cardiomyopathy undergoing CABG, MVRe appears to have a favorable effect on survival. The addition of SVR to CABG may attenuate the anticipated benefits of MVRe by limiting the long-term reduction of MR with MVRe.

Keywords: coronary artery bypass grafting; heart failure; ischemic cardiomyopathy; left ventricular dysfunction; mitral regurgitation; mitral valve repair; surgical ventricular reconstruction

References

  1. Eur J Cardiothorac Surg. 2004 Dec;26 Suppl 1:S42-6; discussion S46-7 - PubMed
  2. Eur J Cardiothorac Surg. 2007 Jul;32(1):52-7 - PubMed
  3. N Engl J Med. 2014 Dec 4;371(23):2178-88 - PubMed
  4. J Thorac Cardiovasc Surg. 2001 Jan;121(1):91-6 - PubMed
  5. N Engl J Med. 2016 May 19;374(20):1932-41 - PubMed
  6. N Engl J Med. 2009 Apr 23;360(17):1705-17 - PubMed
  7. Circulation. 2014 Jun 17;129(24):2547-56 - PubMed
  8. Ann Thorac Surg. 2010 Oct;90(4):1187-94 - PubMed
  9. Circulation. 2012 Nov 20;126(21):2502-10 - PubMed
  10. Circulation. 2003 Sep 9;108 Suppl 1:II241-6 - PubMed
  11. Circulation. 2006 Jul 4;114(1 Suppl):I499-503 - PubMed
  12. J Thorac Cardiovasc Surg. 1995 Apr;109(4):694-701 - PubMed
  13. Circulation. 2012 May 29;125(21):2639-48 - PubMed
  14. J Card Surg. 1998 Nov-Dec;13(6):418-28 - PubMed
  15. J Am Soc Echocardiogr. 2003 Jul;16(7):777-802 - PubMed
  16. Eur J Heart Fail. 2015 Apr;17(4):453-63 - PubMed
  17. J Am Coll Cardiol. 2000 Mar 1;35(3):569-82 - PubMed
  18. J Am Soc Echocardiogr. 2012 Mar;25(3):327-36 - PubMed
  19. J Thorac Cardiovasc Surg. 2007 Dec;134(6):1540-7 - PubMed
  20. J Am Soc Echocardiogr. 2015 Jan;28(1):1-39.e14 - PubMed
  21. Eur J Cardiothorac Surg. 2009 Jun;35(6):995-1003; discussion 1003 - PubMed
  22. Eur J Heart Fail. 2014 Feb;16(2):189-200 - PubMed

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