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Surgical Treatment of Moderate Ischemic Mitral Regurgitation

Thursday, November 20, 2014

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Source Name: New England Journal of Medicine


Peter K. Smith, John D. Puskas, Deborah D. Ascheim, Pierre Voisine, Annetine C. Gelijns, Alan J. Moskowitz, Judy W. Hung, Michael K. Parides, Gorav Ailawadi, Louis P. Perrault, Michael A. Acker, Michael Argenziano, Vinod Thourani, James S. Gammie, Marissa A. Miller, Pierre Pagé, Jessica R. Overbey, Emilia Bagiella, François Dagenais, Eugene H. Blackstone, Irving L. Kron, Daniel J. Goldstein, Eric A. Rose, Ellen G. Moquete, Neal Jeffries, Timothy J. Gardner, Patrick T. O'Gara, John H. Alexander, and Robert E. Michler

301 pts with CAD required revascularization and moderate MR were randomly assigned to CABG or CABG with MV repair.  The outcome was LV end-systolic index at 1 year.  MV repair contributed to longer pump times, longer hospitalization, and more neurologic events.  MV repair did not result in an improved primary outcome at 1 year, but was associated with reduced rates of moderate to severe MR.  The potential benefit of this latter finding is unclear.


My attitude is to reserve the add-on MV +CABG for selected patients who showed: 1-PreOp needs for high doses of diuretics ,inotrops,IABP. 2-PerOp high PA pressure, difficulty to Off Bypass. Once im doing OPCABG as routine, if i go ON that means mostly the patient will need the repair.

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