Transseptal approach versus left atrial approach to mitral valve: a propensity score matching study

Background: Many patients with mitral valve diseases need surgical procedures for the repair or replacement of their mitral valve. There is a great deal of controversy over the outcomes of the transseptal [TS] and left atrial [LA] approaches to the mitral valve. We sought to evaluate the outcomes of each approach more accurately by eliminating the possible biases in case selection and matching

Methods: This retrospective study included patients who had surgery for mitral valve diseases via either the TS approach or the LA approach between 2004 and 2011 in Tehran Heart Center. Patients with surgical approaches other than the TS and LA were excluded. To control for the confounding effects, a propensity score matching technique was applied and the patients were matched for 14 demographic and preoperative variables. After the selection of controls, the effect of the TS approach [163 patients] versus the LA approach [652 patients] on the outcomes was presented through odds ratio [OR] with 95% confidence intervals [CI]

Results: The mean age of the patients was 53.15 +/- 12.02 years in the TS group and 52.93 +/- 13.56 years in the LA group. Females comprised 119 [73.0%] patients in the TS group and 462 [70.9%] in the LA group. There was a significant association in the prevalence of new postoperative atrial fibrillation in the two groups [OR = 1.539, 95%CI: 1.072-2.210; p value = 0.019]. Temporary pacemaker placement had no statistically significant difference between the two groups [p value= 0.418]. The TS patients had significantly longer pump [p value < 0.001] and cross-clamp [p value < 0.001] times. The mortality rate was 4.1% [27 patients] in the LA group and 6.1% [10 patients] in the TS group [p value = 0.274]

Conclusion: In our study population, the TS approach was associated with higher pump and cross-clamp times as well as risk of postoperative atrial fibrillation, but it did not increase the rates of permanent pacemaker placement, re-operations, and mortality

Evaluating the potential effect of melatonin on the post-cardiac surgery sleep disorder

Postoperative neurological injuries, including cognitive dysfunction, sleep disorder, delirium, and anxiety, are the important consequences of coronary artery bypass graft surgery [CABG]. Evidence has shown that postoperative sleep disturbance is partly due to disturbed melatonin secretion in the perioperative period. The aim of this study was to evaluate the effect of melatonin on postoperative sleep disorder in patients undergoing CABG. One hundred forty-five elective CABG patients participated in a randomized double-blind study during the preoperative period. The patients were randomized to receive either 3 mg of melatonin or 10 mg of Oxazepam one hour before sleep time. Each group received the medication from 3 days before surgery until the time of discharge. Sleep quality was evaluated using the Groningen Sleep Quality Score [GSQS], and the incidence of delirium was evaluated by nursing records. Sleep quality and anxiety scores were compared before and after surgery through the Wilcoxon signed-rank test. The analysis of covariance [ANCOVA] and independent t-test were used to compare the sleep and anxiety scores between the groups. P values

Knowledge management in cardiac surgery: the second Tehran heart center adult cardiac surgery database report

The Adult Cardiac Surgery Databank [ACSD] of Tehran Heart Center was established in 2002 with a view to providing clinical prediction rules for outcomes of cardiac procedures, developing risk score systems, and devising clinical guidelines. This is a general analysis of the collected data. All the patients referred to Tehran Heart Center for any kind of heart surgery between 2002 and 2008 were included, and their demographic, medical, clinical, operative, and postoperative data were gathered. This report presents general information as well as in-hospital mortality rates regarding all the cardiac procedures performed in the above time period. There were 24959 procedures performed: 19663 [78.8%] isolated coronary artery bypass grafting surgeries [CABGs]; 1492 [6.0%] isolated valve surgeries; 1437 [5.8%] CABGs concomitant with other procedures; 832 [3.3%] CABGs combined with valve surgeries; 722 [2.9%] valve surgeries concomitant with other procedures; 545 [2.2%] surgeries other than CABG or valve surgery; and 267 [1.1%] CABGs concomitant with valve and other types of surgery. The overall mortality was 205 [1.04%], with the lowest mortality rate [0.47%] in the isolated CABGs and the highest [4.49%] in the CABGs concomitant with valve surgeries and other types of surgery. Meanwhile, the overall mortality rate was higher in the female patients than in the males [1.90% vs. 0.74%, respectively]. Isolated CABG was the most prevalent procedure at our center with the lowest mortality rate. However, the overall mortality was more prevalent in our female patients. This database can serve as a platform for the participation of the other countries in the region in the creation of a regional ACSD.

Continuous sedation-analgesia delays diagnosis of compartment syndrome in a patient with intra-aortic balloon pump

Compartment syndrome is a rare, devastating complication of coronary artery bypass grafting [CABG] and intra-aortic balloon pump [IABP]. Prompt diagnosis is based on symptoms and signs and is paramount for limb rescue. This report describes a CABG patient with IABP in whom receiving continuous analgesia-sedation obscured the symptoms of compartment syndrome

Screening of carotid artery stenosis in coronary artery bypass grafting patients

We sought to evaluate the routine echo-Doppler screening of carotid artery stenosis in patients undergoing coronary artery bypass grafting. A total of 2179 consecutive patients who underwent coronary artery bypass grafting alone or with other cardiac surgery at Tehran Heart center, Tehran-Iran, between January 2005 and January 2006 were included in this retrospective study. Carotid Doppler was performed for 1604 [81.48%] of these patients. The patients' age ranged between 20 and 84 years [mean: 58.33, SD: 10.08 years]. Of the 1604 patients studied, 1186 [73.9%] were men, 592 [36.9%] had diabetes, 598 [37.3%] were smokers, and 194 [12.1%] cases had significant left main stenosis. Twenty-one [1.3%] patients had significant carotid stenosis [> 60% stenosis], which constituted 0.9% of all the bypass surgery candidates. Post-operative cerebrovascular accident was not detected in any of the patients with significant carotid stenosis, but cerebrovascular accident occurred in 22 [1.4%] of the patients without carotid stenosis. Magnetic resonance angiography [MRA] was conducted in 15 patients. In our univariate analysis, female gender [p value = 0.023], hypertension [p value 0.055], peripheral vascular disease [p value < 0.001], and age [p value = 0.001] were significant in the development of carotid stenosis. Pre-operative duplex carotid screening seems to be necessary in patients when there is hypertension, peripheral vascular disease, .female gender, and advanced age

Left-sided endocarditis associated with multi-drug resistance acinetobacter Lwofii

Acinetobacter lwoffii, and important nosocomial pathogen, is a gram-negative aerobic bacillus that is a component of the normal flora on the skin, oropharynx, and perineum of about 20-25% of healthy individuals. We herein present a case of a 66-year-old man with combined mitral and aortic valve endocarditis associated with multi-drug resistance acinetobacter lowffii bacteremia

Impact of isolated coronary artery bypass grafting on non-organic tricuspid regurgitation severity

Moderate non-organic tricuspid regurgitation [TR] concomitant with coronary artery disease is not uncommon, Whether or not TR improves after pure coronary artery bypass grafting [CABG], however, is unclear. The aim of this study was to evaluate the effect of isolated CABG on moderate non-organic TR. This study recruited 50 patients [40% female, mean age: 65.38 +/- 8.01 years, mean left ventricular ejection fraction [LVEF]: 45.74 +/- 13.05%] with moderate non-organic TR who underwent isolated CABG. TR severity before and after CABG was compared. Pulmonary arterial systolic pressure [PAPs] > 30mmHg and LVEF < 50% were considered elevated PAPs [EPAPs] and LV systolic dysfunction, respectively. Presence of Q-wave in leads II, III, and aVF was considered inferior myocardial infarction [inf. MI]. Pre-operatively, 81.5% of the patients had EPAPs, 16% right ventricle [RV] dilation, and 50% left ventricle [LV] and 16% RV systolic dysfunction. TR severity improved in 64% after CABG, whereas it remained unchanged or even worsened in others [P value < 0.001]. Patients with inf. MI showed no improvement in TR, while patients without inf. MI had significant TR regression after CABG [P value= 0.050]. Improvement of TR severity after CABG was not related to pre-operative RV size and function, LV systolic function, or PAPs reduction. Although TR severity decreased remarkably after isolated CABG, a considerable number of the patients had no TR regression. In addition, only absence of inf. MI was significantly correlated to TR improvement after CABG. Further prospective studies with long-term follow-up needed to determine the other factors predicting TR regression after isolated CABG

Impact of diabetes mellitus on peripheral vascular disease concomitant with coronary artery disease

The aim of this study was to evaluate the impact of diabetes mellitus [DM] on peripheral vascular disease [PVD] in patients with coronary artery disease [CAD]. A total of 13702 consecutive patients who underwent coronary artery bypass grafting [CABG] at Tehran Heart Center between January 2002 and March 2007 were included in this study. The demographic data, PVD, and outcome of these patients were reviewed. CABG patients before surgery were detected for PVD [stenosis >/= 70% in the abdominal aorta; renal, carotid, and iliac arteries; or any other peripheral vascular system] with physical examination and past medical history. The suspected cases of PVD were, thereafter, confirmed via Doppler sonography or invasive angiography. This study recruited 4344 diabetic patients [mean age 59.30 +/- 8.7 years] and 9358 non-diabetic patients [mean age 58.42 +/- 9.9 years]. The diabetics were significantly older and had a higher incidence of PVD [2.7% vs. 1.8%], female gender, hypertension, renal failure, smoking, and dyslipidemia than the non-diabetics [P < 0.05]. There was no significant difference between the two groups with regard to family history and left main disease. Also, the mean ejection fraction [EF] was 48.85% +/- 10.4 and 49.35% +/- 10. In the patients with and without DM, respectively; and the difference was significant [P = 0.008]. The in-hospital mortality rate [mortality over a 30-day post-operative period] was 1.8% in the diabetics and 0.7% in the non-diabetics [P < 0.001]. In the multivariate analysis, PVD, left main disease, age, female gender, and EF were significant in the development of mortality amongst the diabetic patients with a respective odds ratio of 4.17, 5.54, 1.03, 2.86, and 0.95 [P

Determinant factors of renal failure after coronary artery bypass grafting with on-pump technique

The aim of the present study was to investigate the determinant factors of acute renal failure [ARF] after isolated on-pump coronary artery bypass grafting [CABG]. This was a retrospective study of 13, 315 adult patients who underwent isolated CABG with cardiopulmonary bypass [CPB] in Tehran Heart Center from May 2002 to May 2007. The exclusion criteria were age <18, concomitant cardiac and/or noncardiac surgical operations, history of renal failure before surgery, and chronic renal failure requiring dialysis. Preoperative and operative variables were measured, and a multivariate logistic regression model was constructed to identify the independent risk factors for developing renal failure after on-pump CABG. Of the 13,315 patients, 3,347 [25.4%] and 90,883 [74.6%] were females and males, respectively, with a mean age of 58.63 +/- 9.48 years. ARF was detected in 85 [0.6%] of the patients with isolated on-pump CABG. The mean age of the patients was 58.63 +/- 9.48 years, and 25.5% of them were female. The multivariate logistic regression analysis identified age [OR = 1.035; p = 0.002], female gender [OR = 1.622; p = 0.037], history of peripheral vascular disease [PVD] [OR = 2.579; p = 0.042], diabetes mellitus [OR = 1.918; p < 0.001], emergent and urgent surgery [OR = 1.744 and OR = 7.901, respectively; p = 0.003], CPB time >70 min [OR = 1.944; p = 0.007], and intra-aortic balloon pump [IABP] insertion [OR = 10.181; p < 0.001] as the independent risk factors for ARF. The data showed that age, female gender, positive history of diabetes and PVD, urgent and emergent surgery, CPB time >70 min, and need for IABP were the independent determinant factors of ARF after on-pump CABG

One-month survival after coronary artery bypass graft [CABG]

To determine One-month survival after CABG in Shariati Hospital. We followed 340 patients who underwent Isolated-CABG in Shariati Hospital and used survival analysis to compare common coronary risk factors and to assess surgical factors related to survival after CABG. Smoking was more prevalent in males than in females but prevalence of hypertension, diabetes and hperlipidemia was greater in women. Female subjects were older, had greater Body Mass Index [BMI] and left ventricular ejection fraction [LVEF] and had undergone more non-elective surgery compared to males. Most patients had received 3 or 4 grafts [range 1-6 grafts]. There was no difference in aortic cross clamp and anesthesia time between the two genders. Females were hospitalized for longer periods after surgery and their mortality rates were greater. One-month survival ratio estimated by the Kaplan Meier method was 97.1% and 88.4% in males and females respectively. The overall survival rate was 95.3%. The factors related to poor survival were: female gender, non-elective surgery, lengthy aortic cross clamp and anesthesia time and the history of: hypertension, hyperlipidemia, previous CABG and CCU hospitalization

Effect of cardiac rehabilitation program on heart rate recovery after percutaneous coronary intervention and coronary artery bypass grafting

The objective of this study was to evaluate the effect of a hospital-based cardiac rehabilitation program on heart rate recovery [HRR] in patients who received percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]. Two hundred forty patients, who completed 24 sessions of a cardiac rehabilitation program [phase 2] after PCI [n=62] or CABG [n=178] at the rehabilitation department of Tehran Heart Center were included in the present study. Demographic and clinical characteristics and exercise capacity at baseline and at follow-up were compared between the two groups. The main outcome measurements were: Resting heart rate, peak heart rate, and HRR. All the patients showed significant improvements in heart rate parameters from the baseline to the last sessions. The profile of atherosclerotic risk factors [except for diabetes mellitus] was similar between the PCI and CABG subjects. After eight weeks of cardiac rehabilitation, HRR increased averagely about 17 and 21 bpm among the CABG and PCI patients, respectively [p=0.019]. The results of the present study were indicative of an increase in HRR over 1 minute in patients irrespective of their initial revascularization modality [i.e. PCI or CABG] after the completion of cardiac rehabilitation. Be that as it may, the PCI patients achieved greater improvement in HRR by comparison with the CABG patients

Coronary artery bypass grafting combined with total occlusion of internal carotid artery

The presence of significant carotid stenosis in coronary artery bypass grafting [CABG] patients increases the risk of either transient ischemic attack or stroke. However, there is a dearth of data on the risk for patients with unilateral total occlusion of the carotid artery. We herein report our results of cardiac surgery in patients with unilateral total occlusion of the carotid artery. We examined 10,000 patients who underwent carotid artery duplex scanning before CABG or other cardiac procedures between January 2001 and September 2006 at Tehran Heart Center. The occlusions were detected via carotid Doppler screening and were confirmed through conventional or MR angiography. Among these patients, 15 [0.15%] patients had unilateral total occlusion of the internal carotid artery, and all of them underwent elective cardiac surgery. During cardiopulmonary bypass, the mean arterial pressure was maintained at above 60 mmHg with vasopressure drugs and increasing flow pump. There were 4 patients with left and 11 patients with right carotid occlusions. Four patients had a history of cerebrovascular accident. The mean cross-clamp time [min] and perfusion time [min] was 50.7 +/- 17.3 and 94.2 +/- 26.7, respectively. The mean graft number was 4.1 +/- 0.9. One of these patients expired intraoperatively because of low cardiac output. In one [6.66%] patient, postoperative cerebrovascular accident occurred on the contralateral side of the totally occluded region. All the patients recovered uneventfully. Our results suggest that CABG can be performed in patients with unilateral total occlusion of the internal carotid artery without ipsilateral stroke using our strategies

Repair versus replacement for ischemic mitral regurgitation

This study was undertaken to compare the outcome in patients with moderate to severe ischemic mitral regurgitation [IMR] undergoing coronary artery bypass grafting [CABG] with either mitral valve repair or mitral valve replacement. Between March 2002 and February 2005, 49 consecutive patients [mean age: 62.84 +/- 8.42 years; mean EuroSCORE: 10.03 +/- 3.12] with coronary artery disease and moderate to severe IMR underwent CABG plus mitral valve replacement or mitral valve repair. The patients with annulus dilatation were more likely to undergo repair. The mean follow-up period was 18.89 +/- 2.1 months. 40.8% of the patients underwent CABG plus mitral valve replacement, and 59.2% had CABG concomitant with mitral valve repair. The total rate of mortality in our population was 14.9% [7 patients] including 10.3% [3 patients] early mortalities; all the deceased patients were in the repair group. Both groups had a similar EuroSCORE, but more patients in the repair group had a recent episode of unstable angina [65.5% vs. 35.0%, respectively; P=0.035] and diabetes mellitus [44.8% vs. 10.0%, respectively; P=0.009]. After the follow-up period, in the repair group, 11.5% had no features of Mitral regurgitation [MR]; while 50% had mild MR, 23.1% moderate MR, 11.5% moderately severe MR, and 3.8% severe MR. Overall, 68.9% had no or mild MR, which we defined as successful repair, and 31.1% had moderate to severe MR. Success of repair and mortality were not statistically related to preoperative ejection fraction [39.2 +/- 7.8% vs. 32.5 +/- 8.5%; P=0.057]. Early mortality was higher in the repair group than that in the replacement group, but this may have been due to the higher frequency of diabetes mellitus and unstable angina in the former group. Future studies are required to determine the benefit of repair versus replacement concomitant with CABG in IMR patients

Prosthetic valve endocarditis: early outcome following medical or surgical treatment

Prosthetic valve endocarditis [PVE] is an important cause of morbidity and mortality associated with heart valve replacement surgery. The aim of the present study was to describe the early outcome of treatment in patients with PVE in a single center. The data of all the episodes of PVE registered at our institution between 2002 and 2007 were collected and analyzed retrospectively. The patients were assessed using clinical criteria defined by Durack and colleagues [Duke criteria]. The analysis included a detailed study of hospital records. The continuous variables were expressed as mean +/- standard deviation, and the discrete variables were presented as percentages. Thirteen patients with PVE were diagnosed and treated at our center during the study period. In all the cases, mechanical prostheses were utilized. The patients' mean age was 46.9 +/- 12.8 years. Women made up 53.8% of all the cases. Early PVE was detected in 6 [46.2%] patients, and late PVE occurred in 7 [53.8%]. Eleven [84.6%] patients were treated with intravenous antimicrobial therapy, and the other two [15.4%] required surgical removal and replacement of the infected prosthesis in addition to antibiotic therapy. Blood cultures became positive in 46.2% of the patients. Mortality rate was 15.4% [2 patients]. It seems that in selected cases with PVE, i.e. in those who remain clinically stable and respond well to antimicrobial therapy, a cure could be achieved by antimicrobial treatment alone with acceptable morbidity and mortality risk

Discrete subvalvular aortic stenosis: severity of aortic regurgitation and rate of recurrence at midterm follow-up after surgery

Discrete subaortic stenosis [DSS] is a progressive condition. Controversy still rumbles on as to whether the subaortic membrane causes aortic regurgitation [AR] and whether membrane resection reduces AR severity. We investigated the association between the left ventricular outflow tract peak gradient [LVOT-PG] and AR severity preoperatively and changes in AR severity and obstruction recurrence after surgery in DSS patients. Twenty patients were evaluated before and after surgery for DSS [mean follow-up time: 13.60 +/- 9.61 months]. The patients were evaluated via transthoracic echocardiography and transesophageal echocardiography, if necessary. The cut-off point for surgery was LVOT-PG ?50 mmHg or the presence of progressive AR. The mean age of the patients was 28.55 +/- 15.23 years, and 35% of them were male. LVOT-PG decreased from a mean of 80.83 +/- 42.72 mmHg preoperatively to 19.14 +/- 14.03 mmHg postoperatively and to 25.47 +/- 16.10 at follow-up. AR was identified in 15 [75%] patients preoperatively: mild in 8 [40%] and moderate in 7 [35%]. The postoperative change in AR severity was insignificant. The correlation between preoperative LVOT-PG and the incidence and severity of preoperative AR was not significant. AR severity had no correlation with age. Membrane recurrence occurred in 25% of the patients. Our results indicated no relationship between AR severity and LVOT-PG and the patient's age. Patient selection for surgery can, therefore, be carried out on the basis of LVOT-PG or AR severity separately. Subaortic resection may reduce AR severity in some patients, but this reduction is not significant. Future studies are required to elucidate whether or not the presence of the AR is an indication for surgery

Early outcome of coronary artery bypass grafting in patients less than 40 years old comparing with eldery patients

Age is one of the most important factors that have consistently emerged as the most potent predictors of mortality and morbidity after coronary artery bypass graft [CABG] surgery. However, early results of CABG in young patients in comparison with elderly ones have been different in previous surveys. The aim of this study was to compare shortterm mortality and morbidity in young versus older patients and evaluate the presence of risk factors and their influence on outcome in both groups. We conducted a retrospective database review of 13222 patients divided into two age groups: patients less than 40 years old [411 patients] and those older [12811 patients], who underwent CABG at Tehran Heart Center between January 2002 and January 2007. We also compared preoperative, operative, and postoperative characteristics between them and assessed the influence of the variables on the length of stay in hospital [LOS] in the two groups. Among postoperative complications, only atrial fibrillation [P<0.001] was more prevalent in the elderly group and other complications were similar. The thirty-day mortality rate was higher in the elderly group [1.1% vs. 0%, P=0.023]. Also, prolonged LOS [P<0.001] and ICU stay [P<0.001] were found more prevalent in the elderly group. Among the preoperative and postoperative variables, emergency surgery, diabetes mellitus, and previous myocardial infarction influenced the prolonged LOS in the young patients. Early mortality rate and prolonged length of stay in ICU and hospital were higher in the elderly than those in the young patients; however, other postoperative early complications were similar between the two groups

Using workload to predict left main coronary artery stenosis in candidates for coronary angiography

Coronary angiography, albeit a safe procedure, may cause serious complications especially in patients with left main stenosis [LMS].This study was designed to investigate the efficacy of workload achieved by exercise tolerance test [ETT] in predicting LMS in candidates for coronary angiography. A total of 743 patients with a positive ETT who subsequently underwent cardiac catheterization were retrospectively studied. Different risk factors were compared among the patients with and without LMS. A multivariate forward stepwise logistic regression analysis was used to identify the main predictors of LMS. Among our 743 patients, 72% were male and 41 [5.5%] had LMS >/= 50%. Patients with LMS, by comparison with those without LMS, were older and were more likely to be male and had higher percentages of ejection fraction less than 35% [EF 7, LMS was found in 8.3% and 3.6%, respectively [P=0.006]. The risk of having LMS in the men with METs 7 [OR=3, P=0.003, 95% CI=1.50-6.00]. Among the patients with LMS, stenosis >/= 70% was found in 44% in METs 7. Lower METs correlated with an increased likelihood of significant LMS in the patients, especially if they were male, who had a positive exercise test and were suspected of coronary artery disease. It is, therefore, advisable that patients with METs

Early outcome of coronary artery bypass grafting in patients with severe left ventricular dysfunction

Left ventricular dysfunction is one of the most powerful predictors of early and late outcomes in patients who undergo coronary artery bypass grafting [CABG]. The aim of this study was to assess the early results of CABG that predict 30-day mortality and prolonged length of hospital stay [LOS] after CABG in patients with an ejection fraction [EF] of 30% or less. Seven hundred seven patients who underwent CABG with EF 30% as the control group. Demographic and clinical characteristics and postoperative complications were considered. The thirty-day mortality rate [2.3% vs. 0.8%, P<0.0001], the mean of LOS [P<0.0001], and the mean of the length of ICU stay [P<0.0001] were higher in the severe left ventricular dysfunction group than in the control group. In patients with severe left ventricular dysfunction, the mean of NYHA score [P=0.0081], prolonged ventilation [P=0.0051], and renal failure [P=0.0606] were related to the 30-day mortality rate. Also, the prolonged LOS in these patients was correlated with the female gender [P=0.0018] and atrial fibrillation [P=0.0164]. Although left ventricular dysfunction is itself an important strong risk factor in patients undergoing CABG, the early outcome of CABG in patients with left ventricular dysfunction is acceptable and the management of this factor will help to reduce the mortality and total length of stay in hospital

Moderate Mitral Regurgitation and Coronary Disease: Treatment with Coronary Bypass Alone?

In cases of moderate[2 or 3+ on a scale of 0 to 4+] nonorganic mitral regurgitation [MR] and coronary artery disease, operative strategy continues to be debated between coronary artery bypass grafting alone [CABG] or concomitant valve repair. To clarify the optimal management of these patients, we evaluated the mid-term results of isolated CABG in the study group. From March 2002 to February 2005, 40 consecutive patients [57.5% male, mean age: 62.45 +/- 8.7 years, mean ejection fraction: 44.15 +/- 12.6%, mean New York Heart Association class 2.5 +/- 0.78] with coronary artery disease and moderate MR without organic mitral valve disease [prolapse, rheumatism, etc.] underwent CABG alone. Thirty one [77.5%] patients had either postoperative or follow-up transthoracic echocardiography with mean follow up time of 10.82 +/- 8.12 months. Patient's pre and postoperative data were compared to evaluate the results of isolated CABG on moderate MR. MR was ischemic [with persistent wall motion abnormality] in 25 [62.5%] patients and functional [without persistent wall motion abnormality] in 15 [31.5%]. Considering postoperative and follow up transthoracic echocardiography, 54.8% had no or mild MR [29% MR 1+, 25.8% no MR] and 45.2% had moderate MR [16.1% MR 3+, 29% MR 2+]. ResoluItion of MR was significant [p<0.001], but it had no correlation with ischemic MR [p=0.46], preoperative ejection fraction [p=0.09], LV systolic [p=0.70] and diastolic dimensions [p=0.80]. Seven patients died, 2 in hospital and 5 later. Although for coronary artery disease accompanying moderate nonorganic MR, CABG alone reduces severlity of MR significantly, many patients are left with moderate MR. Preoperative diagnosis of moderate nonorganic MR may warrant concomitant mitral repair