This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Aseem Ranjan Srivastava Amit Banerjee Joel Dunning Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Srivastava, A. R. Articles by Dunning, J. Search for Related Content PubMed PubMed Citation Articles by Srivastava, A. R. Articles by Dunning, J. Related Collections Cardiac - physiology Cardiac - other Education

Should patients undergoing coronary artery bypass grafting with mild to moderate ischaemic mitral regurgitation also undergo mitral valve repair or replacement?

^a Department of Cardiothoracic and Vascular Surgery, G B Pant Hospital, New Delhi, India
^b Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
^c Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK

*Corresponding author. Tel./fax: +44-780-1548122.

E-mail address: joeldunning{at}doctors.org.uk (J. Dunning).

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether mitral valve repair at the time of coronary artery bypass grafting (CABG) in patients with coronary artery disease and mild to moderate mitral insufficiency improves short and long-term outcome. Altogether 465 papers were found using the reported search, of which 16 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that there is good evidence to suggest that moderate mitral regurgitation in patients undergoing isolated CABG adversely affects survival and mitral regurgitation does not reliably improve after CABG alone. Unfortunately, the evidence to support mitral valve repair at the time of CABG to improve long-term survival is still weak. On balance, patients with moderate ischaemic mitral regurgitation having CABG should have mitral repair at the same time, although the evidence to support this is weaker than one might like.

Key Words: Mitral valve insufficiency; Myocardial revascularization; Mitral repair; Coronary artery bypass graft