Results of coronary bypass and valve operations for mitral valve regurgitation.
Combined coronary bypass grafting and valve procedures for mitral valve regurgitation result in poor outcomes, but the impact of the etiology of valve regurgitation on operative and long-term outcomes is not well defined. A retrospective analysis of 468 patients who had combined coronary bypass grafting and valve operations for mitral regurgitation showed that 78% had valve repairs and 22% had replacements for ischemic (45%) or degenerative (55%) disease. Predictors of operative mortality were ischemic mitral regurgitation, failure to use the internal mammary artery for grafting, severe coronary disease, acute myocardial infarction, low ejection fraction, advanced heart failure, emergency operation, and mitral valve replacement. The 5-year survival rates for propensity-matched patients with ischemic or degenerative disease were similar (66%). Low ejection fraction (< 35%), advanced age (> 67 years), valve replacement surgery, residual mitral regurgitation, and severe coronary artery disease were predictors of poor long-term outcome. Although the operative outcomes of ischemic mitral regurgitation were poor compared to those of degenerative disease, the long-term survival was similar in both groups of propensity-matched patients. Left ventricular remodeling, an optimal valve procedure without residual mitral regurgitation, and left ventricular function are more important determinants of long-term outcome than the etiology of valve regurgitation.
Sirivella
Srikrishna
S
Department of Cardiovascular and Thoracic Surgery, Newark Beth Israel Medical Center, University of Medicine & Dentistry of New Jersey, Newark, NJ, USA.
Gielchinsky
Isaac
I
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D004638:Emergency Treatment / Q000009:adverse effects; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality; D017202:Myocardial Ischemia / Q000150:complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000401:mortality; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000401:mortality; D020257:Ventricular Remodeling