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Background: The best surgical approach for patients with moderate mitral regurgitation of ischemic etiology (IMR) is still undetermined. We examined long term outcomes in patients undergoing coronary bypass (CABG) having moderate IMR, and compared outcomes between those undergoing a restrictive annuloplasty to those not having intervention on the mitral valve.
Methods: A retrospective analysis of our data base revealed 231 patients operated between 1993-2011 with moderate IMR: group 1 (n= 186) underwent isolated CABG, group 2 (n= 45) underwent CABG with concomitant mitral valve annuloplasty. Univariate analysis was used to compare baseline parameters. Kaplan-Meier estimates were used to compare survival. Cox multivariate regression was used to determine predictors for late survival. Survival data up to 20 years is 97% complete.
Results: Preoperative baseline parameters including age, prior MI, LV function, and incidence of atrial fibrillation were similar. Patients undergoing mitral repair had a higher incidence of CHF (p<0.0001). After surgery more repair patients had low cardiac output (p=0.002) and required use of inotropes (p=0.0005). Overall operative mortality was 7% (ns). Ten year survival was 55% and 52% for groups 1 and 2 respectively (p=0.2). Predictors for late mortality included age, symptoms of CHF, LV dimensions and preoperative LV function. Neither the addition of a mitral procedure, type of ring implanted nor residual MR after surgery emerged as predictors for survival.
Conclusions: In patients with moderate IMR, neither operative mortality nor long term survival are affected by the performance of a restrictive annuloplasty. The fact that patients undergoing a mitral procedure had a higher incidence of CHF, yet attained similar survival alludes to the fact that such a procedure is beneficial in terms of survival. The decision to repair the valve should be taken on an individual basis.
