Patients with functional ischemic mitral regurgitation undergoing elective CABG may benefit from additional mitral valve annuloplasty, according to results from the RIME trial, presented Nov. 7 at at AHA 2012. The study found that the combination of procedures, compared to CABG alone, improved functional capacity, left ventricular reverse remodeling, mitral regurgitation and BNP levels at one-year follow-up.

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Patients with functional ischemic mitral regurgitation undergoing elective CABG may benefit from additional mitral valve annuloplasty, according to results from the RIME trial, presented Nov. 7 at at AHA 2012. The study found that the combination of procedures, compared to CABG alone, improved functional capacity, left ventricular reverse remodeling, mitral regurgitation and BNP levels at one-year follow-up.

The study's primary endpoint — functional capacity — defined as peak oxygen consumption at one year, improved significantly among patients who underwent CABG and mitral valve repair. There was a 22 percent increase from baseline in patients receiving both procedures versus a 5 percent change with CABG alone (p<0.001). At one year, 76 percent of patients who underwent both procedures were in NYHA class I, and 74 percent had no mitral regurgitation. In the CABG-only arm, the rates were 21 percent and 9 percent, respectively (p=0.03 for functional class comparison; p<0.001 for mitral regurgitation comparison). Secondary endpoints, such as left ventricular reverse remodeling, mitral regurgitation volume and BNP levels, were also improved at one year with the combined procedures.

The combination of procedures was, however, associated with longer operation times, an increased need for intubation, longer hospital stays and a greater volume of blood transfused. Lead investigator K. M. John Chan, BMBS, National Heart and Lung Institute, Imperial College London, noted that the study was not powered for evaluating clinical outcomes or survival, and that long-term follow-up remains necessary. Nevertheless, the trialists concluded that the combination of CABG and mitral valve annuloplasty, compared to CABG alone, improves functional capacity and other outcomes in patients with functional ischemic mitral regurgitation.

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