E270 ABSTRACT Background: This is a prospective randomized-controlled study done to evaluate the best surgical option for moderate ischemic mitral regurgitation through either coronary artery bypass grafting only or by performing additional mitral repair. Methods: Over a nine-month period, 60 patients with ischemic heart disease associated with moderate ischemic mitral regurgitation were equally divided into two groups. Group 1 included 30 patients who had coronary artery bypass grafting with mitral valve repair; Group 2 included 30 patients who had only coronary artery bypass grafting. Results: There were no significant differences between the study groups, regarding operative data, apart from the cardiopulmonary bypass time and aortic cross-clamp time, which were significantly longer in group 1 (P < 0.001). Only one patient died in group 1 due to severe myocardial dys- function. During the follow up, the NYHA class improved in group 1, from 2.7 to 1.35 (P < 0.004), compared with group 2, where the NYHA class improved from 2.6 to 1.72 (P = 0.07). The degree of MR improved in 28 patients (93%) in group 1 and 22 patients (73%) in group 2 (P < 0.0001). Conclusion: The study revealed many advantages of adding mitral repair to surgical revascularization in patients with mod- erate ischemic mitral regurgitation, with improvement in the degree of MR and NYHA functional class. On the other hand there were no significant differences between the groups, regarding the postoperative course and incidence of mortality. INTRODUCTION Ischemic mitral regurgitation is defined as mitral regur- gitation resulting from myocardial infarction (MI) or ischemic heart disease, without structural damage to the subvalvular mitral apparatus [Gorman 2003]. Valvular incompetence in this case is due to papillary muscle (PM) displacement, leaflet shortening, and dilatation of the mitral annulus [Kumanohoso 2003]. There is no debate in general on the fact that severe (grades 3+ to 4+) chronic ischemic mitral regurgitation (CIMR) should be addressed by valve repair in conjunction with coronary artery bypass grafting (CABG), whereas mild (grade 1+) CIMR does not warrant intervention. Meanwhile, the optimal management of moderate (grade 2+) CIMR still is debatable [Fattouch 2009]. This controversy is partly due to the lack of data from larger studies to determine whether the advantages of concomitant mitral repair (MVR) and CABG would worth the risks of this complex and lengthy procedure or not [El Bardissi 2012; Lee 2011]. The argument of the authors favoring surgical revascularization alone for the man- agement of ischemic mitral regurgitation is that restoring the blood supply to the ischemic myocardium will improve the LV function and consequently reduce its size, improve papil- lary muscle function as well as the integrity of the subvalvular apparatus [Penicka 2009; Roshanali 2006]. Supporters of combined mitral repair and CABG seriously consider the adverse effects of persistent ischemic mitral regurgitation and additionally argue that in patients with poor LV function, mitral valve repair has the advantages of preventing progressive adverse remodeling, improving the myocardial function, and decreasing the incidence of heart failure [Flynn 2009; Bax 2004]. PATIENTS AND METHODS This prospective randomized-controlled study was done at the Cairo University Hospital between March to Decem- ber 2014. The study included 60 ischemic patients with a moderate degree of ischemic mitral regurgitation (IMR) who were candidates for CABG surgery. Moderate IMR was confirmed by transesophageal echocardiography (TEE). Excluded from our study were patients with a mild or severe degree of IMR, MR not of ischemic origin (rheumatic), other valve diseases warranting intervention, associated left ventricular aneurysm or ischemic VSD, and previous open heart surgeries (redo cases) as well as off-pump cases. Patients were divided into two groups of 30 patients each, using propensity scores according to patient characteristics. Group 1 patients were assigned for on-pump CABG and mitral repair; Group 2 patients were to have only on-pump CABG. The diagnosis and severity of IHD were assessed by Te Heart Surgery Forum #2019-2773 23 (3), 2020 [Epub May 2020] doi: 10.1532/hsf.2773 Results of Coronary Artery Bypass Grafing Alone Versus Combined Surgical Revascularization and Mitral Repair In Patients with Moderate Ischemic Mitral Regurgitation Ahmed Khallaf, 1 Mahmoud Elzayadi, 1 Hesham Alkady, 2 Ahmed Elnaggar 2 1 Department of Cardiothoracic Surgery, Fayoum University, Fayoum, Egypt; 2 Department of Cardiothoracic Surgery, Cairo University, Egypt Received October 14, 2019; accepted March 10, 2020. Correspondence: Ahmed Khallaf, Department of Cardiothoracic Surgery, Fayoum University, Fayoum, Egypt (e-mail: ankhallaf@gmail.com). Online address: http://journal.hsforum.com