Moderate mitral regurgitation at the time of coronary bypass surgery: repair or leave it?

Abstract

Moderate ischemic mitral regurgitation (IMR) is a common finding in patients undergoing coronary artery bypass grafting (CABG). In this review, we summarize the current evidence on the optimal management of this condition. In recent years, several randomized clinical trials have assessed the impact of concomitant restrictive mitral annuloplasty at the time of CABG on reverse left ventricular remodeling, IMR reduction and clinical outcomes. Surgical revascularization alone is a conservative strategy that reduces IMR in a significant proportion of patients. Concomitant restrictive annuloplasty provides better relief of mitral regurgitation in the immediate postoperative period, at the cost of increased perioperative morbidity. The only major randomized trial on the issue of moderate IMR published to date showed no difference in reverse left ventricular remodeling at 1 year between these two approaches. There are insufficient data in the literature to support the routine addition of mitral valve repair to CABG in patients with moderate IMR.