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 patientsundergoing primary mitral valve surgery for pure mitral regurgitation withcoronary artery disease (MR + CAD, 79 patients) or without (MR no CAD, 102patients). Early mortality (C10% vs. 3%) and 6- year estimate of survival(55% +/- 7.1% vs. 82% +/- 4.4%) were significantly different. Mortality wasnot significantly different in patients with CAD + MR of an ischemic (49patients) or a non-ischemic etiology (30 patients). Multivariate testingusing Cox regression models of overall mortality in patients with MR + CADindicated that preoperative renal dysfunction, high right atrial pressure,ejection fraction less than 45% as well as qualitatively reduced leftventricular function and left ventricular end-diastolic volume indexgreater than 120 ml/m2 are associated with decreased survival. Multivariatetesting in patients with MR no CAD only identified insertion of amechanical prosthesis and a degenerative etiology of mitral valve diseaseas independent predictors of survival. Thus, a common denominator ofpreoperative pathology (renal dysfunction) and indices of right and leftventricular dysfunction determined overall survival of patients with MR +CAD. Survival of patients with MR no CAD was determined by the valveprosthesis and the etiology of valve disease.