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Eur J Cardiothorac Surg 2006;29:353-354
© 2006 Elsevier Science NL

Editorial comment

Mild–moderate ischemic mitral regurgitation: should it be treated together with CABG?

Cardiothoracic Surgery, University Hospital, 3000-075 Coimbra, Portugal

^_* Tel.: +351 239 400418; fax: +351 239 829674. (Email: antunes.cct.huc@sapo.pt).

The first 20% of the full text of this article appears below.

In a paper published in this issue of the Journal, Campwala et al. [1] review their patients who were subjected to coronary artery bypass surgery (CABG), looking for incidence, predictors and mechanisms of progression of pre-existing or de novo mitral regurgitation (MR). They found that the development of significant MR following isolated CABG is common (16% of their cases). Progression from mild (2+) to moderate or severe MR was observed in one quarter of the patients. Female gender, history of renal insufficiency, lack of beta-blocker use, MR grade and presence of left bundle branch block were found to be independent predictors of MR progression.

The authors attempted to discuss the pathogenesis of mitral regurgitation and hypothesise that it may occur especially in patients with inadequate revascularization, especially in the area of the posterior descending artery, and in patients with ‘natural progression of LV remodelling’. They believe that MR post-CABG may be prevented by an aggressive revascularization strategy, especially in patients with disease of the posterior descending artery, hibernating myocardium or 2+ mitral regurgitation and other risk factors for development of MR. They recommend ‘strong consideration’ of mitral valve repair concomitantly with CABG in patients with mild (2+) MR, as development of moderate to severe (3 to 4+) MR is very common in these cases.

This is an interesting observational study. To my knowledge, it is the first to analyse . . . [Full Text of this Article]