Response to Letter Regarding Article, “Surgical Revascularization Is Associated With Maximal Survival in Patients With Ischemic Mitral Regurgitation: A 20-year Experience”

Our gratitude to Dr Durukan for his thoughtful review of our study regarding treatment options for ischemic mitral regurgitation (IMR).1 His correspondence highlights an important point of debate regarding the pathophysiology of IMR and the capacity for restoration of mitral valve competence with revascularization alone. As research in this dynamic field continues to progress, it is important to reevaluate previous viewpoints on disease mechanisms and treatment paradigms. We would therefore caution against an inflexible approach to understanding this disease process in light of the continued advancement in available evidence to guide clinical decisions, such as the information provided by our current study. To this end, many have called for randomized trials to further elucidate optimal treatment strategies for IMR. The Cardiothoracic Surgical Trials Network has recently reported the results of a prospective, multicenter, randomized clinical trial comparing coronary artery bypass grafting (CABG) alone to CABG combined with mitral valve repair for moderate IMR treatment, …