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Mitral repair is superior to replacement when associated with coronary artery disease

T Brett Reece1, Curtis G Tribble, Peter I Ellman

  • 1Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia Health Sciences Center, MR$ Building, Room 3116, Charlottesville, VA 22908, USA. tbr5q@virginia.edu

Annals of Surgery
|April 15, 2004
PubMed

Insights

Mitral repair offers better outcomes than replacement in patients needing both coronary artery bypass grafting and mitral valve surgery. Repair significantly reduces hospital mortality and complications compared to replacement in ischemic mitral regurgitation.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Valve Repair and Replacement
  • Ischemic Mitral Regurgitation

Background:

  • Combined coronary artery bypass grafting (CABG) and mitral procedures carry high mortality rates (>10%).
  • Mitral valve replacement (MVR) with subvalvular apparatus preservation may offer comparable results to mitral repair in CABG patients.

Purpose of the Study:

  • To compare the perioperative outcomes of mitral valve repair versus replacement in patients undergoing concurrent CABG for ischemic mitral regurgitation.
  • To evaluate hospital mortality and complication rates, including infection, stroke, pulmonary, and renal issues.

Main Methods:

  • A retrospective study comparing 54 patients who underwent CABG/mitral repair with 56 patients who had CABG/MVR (subvalvular sparing) over seven years.
  • Patient groups were similar in age (mean 67-69 years).
  • Outcomes assessed included hospital mortality, infection, stroke, pulmonary complications, and renal complications.

Main Results:

  • Mitral repair group showed significantly lower hospital mortality (1.9% vs. 10.7%, P=0.05).
  • No significant differences were observed in infection rates (9% vs. 13%), stroke incidence (2 vs. 2), pulmonary complications (39% vs. 32%), or renal complications (15% vs. 18%).

Conclusions:

  • Mitral repair is superior to mitral replacement in patients with coronary artery disease and ischemic mitral regurgitation, offering improved perioperative morbidity and reduced hospital mortality.
  • Despite theoretical advantages of MVR with subvalvular preservation, mitral repair provides a clear survival benefit in this patient population.
Abstract

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