Multivessel Coronary Drug-Eluting Stenting Alone in Patients with Significant Ischemic Mitral Regurgitation: A 4-Year Follow Up

Objective. Is there a role for multivessel drug-eluting stenting alone in the treatment of patients with concomitant significant ischemic mitral regurgitation and coronary artery disease? Methods. In 2003, a single medical center in Honolulu, Hawaii, performed a total of 6 cases of coronary revascularization in patients with concomitant significant ischemic mitral regurgitation (MR). All 6 patients had at least 3-4+ grade MR by echocardiography. All 6 patients had clinical presentation of myocardial ischemia. Of the 6 patients, 2 underwent percutaneous coronary intervention (PCI) alone, 2 had coronary artery bypass graft surgery (CABG) alone, and 2 had combined CABG + mitral valve repair (MVR). The patients were followed for 4 years for cardiac death, myocardial infarction or target lesion revascularization. Results. Clinical follow up after the index procedure showed significant improvement in MR in all patients. Left ventricular ejection fraction improved in both the PCI-only patients, in 1 of 2 CABG-only patients and no improvement in the CABG + MVR group. Incomplete revascularization occurred in patient in the PCI-only arm, both patients in the CABG-arm and in 1 of 2 in the combined surgical arm. At 48 months, the only endpoint observed was 1 cardiac death in the CABG-only arm. Conclusions. Multivessel PCI with drug-eluting stems appears to be an acceptable first treatment for patients with concomitant severe multivessel coronary, artery disease and ischemic MR. For those with no improvement in MR after PCI, MVR can be a later hybrid procedure.