title: Does mitral valve intervention have an impact on late survival in ischemic cardiomyopathy?
abstract: BACKGROUND
  Ischemic mitral regurgitation is associated with reduced survival after coronary artery bypass surgery.
  
  
  OBJECTIVE
  To compare long-term survival among patients undergoing coronary surgery for reduced left ventricular function and severe ischemic MR in whom the valve was repaired, replaced, or no intervention was performed.
  
  
  METHODS
  Eighty patients with severe left ventricular dysfunction and severe MR underwent coronary bypass surgery. The mean age of the patients was 65 years (range 42-82), and 63 (79%) were male. Sixty-three (79%) were in preoperative NYHA functional class III-IV (mean NYHA 3.3), and 26 (32%) were operated on an urgent/emergent basis. Coronary artery bypass surgery was performed in all patients. The mitral valve was repaired in 38 and replaced in 14, and in 28 there was no intervention. The clinical profile was similar in the three groups, although patients undergoing repair were slightly younger.
  
  
  RESULTS
  Operative mortality was 15% (8%, 14%, and 25% for the repair, replacement and no intervention respectively; not significant). Long-term follow up was 100% complete, for a mean of 38 months (range 2-92). Twenty-nine patients (57%) were in NYHA I-II (mean NYHA 2.3). Among the surgery survivors, late survival was improved in the repair group compared to the other groups (P < 0.05). Predictors for late mortality were non-repair of the mitral valve, residual MR, and stroke (P = 0.005).
  
  
  CONCLUSIONS
  Patients with severe ischemic cardiomyopathy and severe MR undergoing coronary bypass surgery should have a mitral procedure at the time of surgery. Mitral valve repair offers a survival advantage as compared to replacement or no intervention on the valve. Patients with residual MR had the worst results.
authors.affiliation: Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel. ssilberman@szmc.org.il
authors.forename: Shuli
authors.initials: S
authors.lastname: Silberman
authors.forename: Avraham
authors.initials: A
authors.lastname: Oren
authors.forename: Marc W
authors.initials: MW
authors.lastname: Klutstein
authors.forename: Maher
authors.initials: M
authors.lastname: Deeb
authors.forename: Esther
authors.initials: E
authors.lastname: Asher
authors.forename: Ofer
authors.initials: O
authors.lastname: Merin
authors.forename: Daniel
authors.initials: D
authors.lastname: Fink
authors.forename: Dani
authors.initials: D
authors.lastname: Bitran
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications / Q000601:surgery*; D011184:Postoperative Period; D011379:Prognosis; D016019:Survival Analysis