title: Determinants of survival after surgery for mitral valve regurgitation in patients with and without coronary artery disease.
abstract: Mortality and its determinants were assessed in 181 consecutive patients undergoing primary mitral valve surgery for pure mitral regurgitation with coronary artery disease (MR + CAD, 79 patients) or without (MR no CAD, 102 patients). Early mortality (C10% vs. 3%) and 6-year estimate of survival (55% +/- 7.1% vs. 82% +/- 4.4%) were significantly different. Mortality was not significantly different in patients with CAD + MR of an ischemic (49 patients) or a non-ischemic etiology (30 patients). Multivariate testing using Cox regression models of overall mortality in patients with MR + CAD indicated that preoperative renal dysfunction, high right atrial pressure, ejection fraction less than 45% as well as qualitatively reduced left ventricular function and left ventricular end-diastolic volume index greater than 120 ml/m2 are associated with decreased survival. Multivariate testing in patients with MR no CAD only identified insertion of a mechanical prosthesis and a degenerative etiology of mitral valve disease as independent predictors of survival. Thus, a common denominator of preoperative pathology (renal dysfunction) and indices of right and left ventricular dysfunction determined overall survival of patients with MR + CAD. Survival of patients with MR no CAD was determined by the valve prosthesis and the etiology of valve disease.
authors.affiliation: Department of Cardiopulmonary Surgery, Dijkzigt Hospital, Erasmus University, Rotterdam, The Netherlands.
authors.forename: L A
authors.initials: LA
authors.lastname: van Herwerden
authors.forename: D
authors.initials: D
authors.lastname: Tjan
authors.forename: J G
authors.initials: JG
authors.lastname: Tijssen
authors.forename: J M
authors.initials: JM
authors.lastname: Quaegebeur
authors.forename: E
authors.initials: E
authors.lastname: Bos
mesh_terms: D003327:Coronary Disease / Q000150:complications / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000401:mortality* / Q000601:surgery; D012044:Regression Analysis; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors