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Ischemic versus degenerative mitral regurgitation: does etiology affect survival?
A Marc Gillinov1, Eugene H Blackstone, Jeevanantham Rajeswaran
1Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. gillinom@ccf.org
The Annals of Thoracic Surgery
|August 27, 2005
Summary
Survival outcomes for ischemic mitral regurgitation (MR) and degenerative MR differ significantly. However, when patients with degenerative MR undergo coronary artery bypass grafting (CABG), their prognosis becomes similar to that of ischemic MR patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Outcomes Research
Background:
- Ischemic mitral regurgitation (MR) is linked to poor survival, while degenerative MR typically has an excellent prognosis.
- This study investigates whether patients with degenerative MR undergoing coronary artery bypass grafting (CABG) experience survival rates comparable to those with ischemic MR.
Purpose of the Study:
- To determine the survival impact of MR etiology (degenerative vs. ischemic) in patients undergoing combined mitral valve repair and CABG.
- To explore survival differences within degenerative and ischemic MR groups.
Main Methods:
- Propensity matching was used to compare 710 patients with degenerative MR and concomitant CABG against 400 patients with functional ischemic MR and CABG.
- Matching criteria included demographics, symptoms, comorbidities, coronary artery disease extent, and left ventricular function.
Main Results:
- Unadjusted 5-year survival was 64% for ischemic MR and 82% for degenerative MR.
- After propensity matching, 123 pairs of ischemic and degenerative MR patients showed similar 5-year survival rates (66% vs. 65%).
- Within the degenerative MR group, survival varied significantly based on ischemic burden and left ventricular dysfunction.
Conclusions:
- The survival disparity between ischemic and degenerative MR is largely due to differences in patient profiles, especially ischemic disease extent and left ventricular function.
- Ischemic and degenerative MR patients with similar clinical characteristics exhibit comparable survival rates.