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Clinical outcomes of surgery of mitral valve regurgitation and coronary artery bypass grafting

Newark Beth Israel Medical Center, Department of Cardiovascular and Thoracic Surgery, Newark University of Medicine & Dentistry of New Jersey, Newark, NJ 07112, USA

*Corresponding author: 28 Cathedral Gardens Road, BRS Hospitals, Nungambakkam, Madras 600-034, India. Tel.: +91-44-2825-5859; fax: +91-44-2491-0910.

E-mail address: ssirivella475{at}yahoo.com (S.Sirivella).

The impact of etiology of associated mitral valve regurgitation and a valve procedure on operative and long-term outcomes after coronary bypass grafting surgery is yet to be clearly defined. Results of combined coronary artery bypass grafting and valve procedures for mitral valve regurgitation were retrospectively analyzed in 468 patients. The regurgitation was of ischemic in 45%, degenerative in 55% and 78% valve repairs, 22% valve replacements were performed. Severe coronary artery disease, acute myocardial infarction, low ejection fraction, ischemic mitral regurgitation, advanced heart failure symptoms, failure to use internal mammary artery, valve replacement surgery, and emergency operations are predictors of operative mortality. The 5-year survivals for propensity-matched patients of ischemic and degenerative disease were similar (66%), but 67% vs. 83%, respectively, for unmatched patients. 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 survival. Left ventricular remodeling processes, optimal valve procedure without residual mitral regurgitation and left ventricular function are important determinants of long-term outcome than the etiology of valve regurgitation.

Key Words: Coronary artery bypass grafts (CABG); Ischemic mitral regurgitation; Mitral valve repair; Mitral valve replacement; Outcomes