Long-term results of operations for mitral regurgitation secondary to coronary artery disease

There are few published reports regarding the long-term results of the operative treatment of significant mitral regurgitation secondary to coronary artery occlusive disease. The few available reports deal with mitral replacement and myocardial revascularization. We prefer repair of the mitral apparatus to replacement, whether combined with myocardial revascularization or done alone. On the basis of our experience with 141 patients requiring myocardial revascularization with mitral valve repair or replacement over the past 12 years, we have come to the following conclusions: Good long-term survival and short-term results can be expected when patients with symptomatic mitral regurgitation and coronary artery disease require surgical treatment. The in-hospital mortality in these patients approaches 15 percent. Patients who are so symptomatic that they require operation within 60 days of a myocardial infarction can be helped but will have poorer results than patients with more remote events. Patients with poor ejection fractions do worse than patients with good ejection fractions. Mitral valve repair is superior to mitral valve replacement. Left ventricular end-diastolic pressure, peak systolic pulmonary artery pressure, and the grade of mitral regurgitation do not seem to be significant determinants of outcome and should not be the basis for denying operation to symptomatic patients. Patients with minimal mitral regurgitation (grade 1/6) and good ventricular function should not undergo corrective valve operation because of the unduly high risk that valve replacement will be required.