Influence of concomitant mitral valve intervention on late survival in patients with moderate ischemic mitral...

In patients with moderate ischemic mitral regurgitation, the influence of concomitant mitral valve (MV) intervention at the time of revascularization on late survival remains unclear. The purpose of this study was to compare the lifetime survival of patients with moderate ischemic mitral regurgitation who underwent revascularization alone versus concomitant MV repair or replacement.

Retrospective review was performed for 776 consecutive patients, ages 65 years and older with coronary artery disease and moderate ischemic mitral regurgitation who underwent isolated coronary artery bypass grafting (CABG) (n = 372), CABG with MV repair (n = 131, CABG + MV repair), or CABG with MV replacement (n = 273, CABG + MV replacement) from 1976 to 2005. Propensity score matching, Kaplan-Meier survival analysis, and Cox regression were used to compare perioperative and long-term survival. Cross-sectional follow-up utilized the Centers for Disease Control and Prevention National Death Index as well as government and genealogical internet sites, publicly available online obituaries, and death notices. Follow up was 98% complete.

The mean age of the cohort was 74.1 ± 5.8 years with 42.4% female patients. Preoperatively, 54.5% had prior myocardial infarction, 47.7% had a history of congestive heart failure, and 69.1% had an abnormal ejection fraction. Matched patients undergoing CABG or CABG + MV repair had similar incidence of major perioperative morbidity (29.0% vs 22.1%; P = .202) and operative mortality (8.4% vs 6.1%; P = .475). Late survival was similar between groups (P = .630). Among matched patients undergoing CABG versus CABG + MV replacement, those undergoing concomitant replacement had significantly increased perioperative major morbidity (35.2% vs 20.9%; P < .001) and operative mortality (16.9% vs 7.7%; P < .001). CABG + MV replacement patients experienced an increased risk of late mortality (hazard ratio, 1.23; 95% CI, 1.01-1.49; P = .035), compared with those undergoing isolated CABG.

In patients with moderate ischemic mitral regurgitation undergoing surgical revascularization, concomitant MV repair did not demonstrate a clear late survival benefit over isolated CABG, whereas concomitant MV replacement was associated with increased early and late mortality risk.