Off Pump Coronary Artery Bypass versus Mitral Annuloplasty in Moderate Ischemic Mitral Regurgitation

Purpose: To compare the outcomes of isolated off-pump coronary artery bypass grafting (OPCAB) to those of mitral annuloplasty (MAP) with revascularization in patients with moderate ischemic mitral regurgitation (MR). Methods: Between April 2001 and December 2009, 140 patients with moderate ischemic MR who underwent isolated OPCAB (OPCAB group, n = 77) or MAP with revascularization (MAP group, n = 63) were analyzed. Results: Freedom from cardiac-related death at eight years was similar between groups (78.4 +/- 5.5%, the OPCAB group versus 81.5 +/- 5.9%, the MAP group, p = 0.297). In patients with left ventricular ejection fraction (LVEF) >40%, the MAP group were similar to the OPCAB group in freedom from recurrent MR at eight years (85.7 +/- 10.0% versus 84.9 +/- 8.3%, p = 0.738), but a significant difference was found in patients with LVEF <= 40% (93.5 +/- 4.5%, the MAP group versus 36.9 +/- 18.4%, the OPCAB group, p = 0.013). On multivariate analysis, emergency operation and low LVEF were predictive of recurrent MR. Conclusion: Concomitant MAP was more effective against recurrent MR than was OPCAB alone, in patients with LVEF <= 40%. We suggest that MAP should be considered in moderate ischemic MR with low LVEF.