title: Long-term survival after surgical revascularization for moderate ischemic mitral regurgitation.
abstract: BACKGROUND
  We sought to characterize patient survival and degree of late mitral regurgitation (MR) in patients undergoing surgical revascularization with moderate ischemic MR.
  
  
  METHODS
  We retrospectively reviewed 251 patients undergoing coronary artery bypass graft (CABG) surgery between 1991 and 2001 with 3+ ischemic MR, including 31 patients who had concomitant mitral annuloplasty. Univariate and multivariable testing was employed.
  
  
  RESULTS
  Actuarial 1-, 5-, and 10-year survival was 84.0%, 67.5%, and 37.1% in the overall group of 251 patients. Independent predictors of long-term mortality were age 70 years or more (hazard ratio 2.50 [95% confidence interval 1.82 to 3.44]), prior myocardial infarction (3.99 [2.15 to 7.39]), unstable angina (2.27 [1.69 to 3.04]), chronic renal failure (4.87 [3.13 to 7.58]), atrial fibrillation (2.21 [1.65 to 2.96]), left internal mammary artery to left anterior descending artery graft (0.28 [0.18 to 0.43]), preoperative beta-blocker (0.43 [0.28 to 0.67]), ejection fraction (0.71/10% [0.64 to 0.80]), left atrium size (0.88/mm [0.84 to 0.92]), diffuse wall motion abnormalities (2.83 [1.77 to 4.55]), and mitral leaflet restriction (3.85 [2.46 to 5.99]). The model controlled for the performance of annuloplasty, which did not emerge as an independent predictor. Patients undergoing annuloplasty did have less mean late MR than those having CABG alone (p = 0.005). Overall, 57.8% of patients (63 of 109) with follow-up echocardiograms had improvement in grade of MR compared with baseline. In 54 of 95 patients (56.8%), intraoperative transesophageal echocardiography downgraded the degree of MR compared with the preoperative study.
  
  
  CONCLUSIONS
  Patients with moderate ischemic MR undergoing CABG had relatively poor long-term survival, with significant differences when stratified according to preoperative characteristics. Performance of mitral annuloplasty reduced the degree of regurgitation but was not a predictor of long-term survival. Intraoperative transesophageal echocardiography frequently downgraded the degree of MR.
authors.affiliation: Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Wong
authors.forename: Arvind K
authors.initials: AK
authors.lastname: Agnihotri
authors.forename: Judy W
authors.initials: JW
authors.lastname: Hung
authors.forename: Gus J
authors.initials: GJ
authors.lastname: Vlahakes
authors.forename: Cary W
authors.initials: CW
authors.lastname: Akins
authors.forename: Alan D
authors.initials: AD
authors.lastname: Hilgenberg
authors.forename: Joren C
authors.initials: JC
authors.lastname: Madsen
authors.forename: Thomas E
authors.initials: TE
authors.lastname: MacGillivray
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
authors.forename: David F
authors.initials: DF
authors.lastname: Torchiana
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000401:mortality; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors