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The Journal of Thoracic and Cardiovascular Surgery, Vol 91, 379-388, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
MW Connolly, JS Gelbfish, IJ Jacobowitz, DM Rose, A Mendelsohn, PM Cappabianca, AJ Acinapura and JN Cunningham Jr
Results of coronary artery bypass grafting with and without mitral valve
replacement were analyzed retrospectively in 101 patients with preoperative
ischemic mitral regurgitation to determine the effects of severity and
surgical treatment of mitral regurgitation on survival. Between 1980 and
1984, a total of 1,475 patients (mean age 59, 77% male) underwent coronary
bypass. These patients were divided into three groups: (1) patients without
ischemic mitral regurgitation who underwent isolated coronary bypass
(1,374; 93%), (2) patients with ischemic mitral regurgitation who underwent
isolated coronary bypass without valve replacement (85; 6%), and (3)
patients with ischemic mitral regurgitation who underwent combined mitral
valve replacement and coronary bypass (16; 1%). Preoperatively, patients
with ischemic mitral regurgitation compared to those without regurgitation
were significantly older (+6 years, p less than 0.001), had more severe
coronary artery disease (p less than 0.001), a higher incidence of
congestive heart failure (24% versus 5%, p less than 0.001) and recent
myocardial infarction (16% versus 8%, p less than 0.01), and a lower mean
ejection fraction (45% versus 61%, p less than 0.001). Operative mortality
was significantly increased in patients with ischemic mitral regurgitation
who underwent coronary bypass alone (p less than 0.01) and in those who
underwent coronary bypass and mitral valve replacement (p less than
0.01)--11% and 19%, respectively--than in the coronary bypass patients
without ischemic mitral regurgitation (3.7%). The severity of mitral
regurgitation (0 to 4+) proved to be the most significant predictor of
operative mortality. The actuarial survival rate at 5 years for the
coronary bypass patients without ischemic mitral regurgitation was 85%
compared to 91% (p less than 0.05) for the coronary bypass patients without
ischemic mitral regurgitation. These results indicate that patients with
ischemic mitral regurgitation have a higher prevalence of cardiac risk
factors and are at an increased risk of operative mortality. Although the
severity of the ischemic mitral regurgitation was strongly predictive of
early survival, it proved to have an unexpectedly modest effect on
long-term survival after surgical treatment.
ARTICLES
Surgical results for mitral regurgitation from coronary artery disease
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