Determinants of survival after surgery for mitral valve regurgitation in patients with and without coronary artery disease

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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.

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