Ischemic Heart Failure Trial Commentary : Alec Vahanian Bichat - PowerPoint PPT Presentation

Influence of Mitral Regurgitation on Survival in the Surgical Treatment for Ischemic Heart Failure Trial Commentary : Alec Vahanian Bichat Hospital, Paris, France

Disclosure Information A) Relationship with companies who manufacture products used in the treatment of the subjects under discussion Relationship Manufacturer(s) Speaker's Honoraria Edwards Lifesciences Consultant (Advisory Board) Medtronic, Abbott, Valtech

 A large contemporary study, including well characterised patients with Low LV ejection fraction, and a long Follow-up

IMR in Candidates for CABG and Low EF Findings :  Moderate and severe IMR are frequent (18%) in patients with Low EF considered for CABG  Patients with “significant” IMR have worse presenting characteristics (higher NYHA classIII/IV, lower LVEF, larger LVESI, higher estimated operative risk) Remarks : Limitations in the assessment of severity of MR ( absence of Corelab, integrative quantification ?) Merging moderate and severe MR is unusual

All-Cause Mortality Estimates for 534 MED Patients by MR Severity Remark :Is IMR « the chicken or the egg » in patients with IMR and LV dysfunction?

Patients with Moderate /Severe MR undergoing CABG+/- MVR  91Pts, 49 underwent MVR  Patients who underwent MVR had : More pre op. PCI, worse LVEF, larger LVESVI, More complicated post operative outcome BUT only 2% operative mortality

All-Cause Mortality Estimates for 195 Patients with Moderate/Severe MR Adjusted CABG + MVP : CABG 0.45 0.23, 0.90

Patients with Moderate /Severe MR undergoing CABG+/- MVR Remarks :  Decision of MVR left to the operator  Possibility of heterogeneity in repair techniques  Limitations in design: No RCT, no Multivariate analysis  Lack of information on: residual MR, re-hospitalisations

What is Needed to Improve the Evidence on Usefulness of MVR in Ischemic MR?  Dedicated RCT  Improvement of Pre operative evaluation Comprehensive quantification of MR at rest and dynamic Identification of predictors of recurrence of MR Myocardial viability  Evaluation of Techniques Annuloplasty, including dynamic components LV « remodelling » Percutaneous techniques…

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