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Daniel R. Wong
Arvind K. Agnihotri
Gus J. Vlahakes
Cary W. Akins
Joren C. Madsen
Thomas E. MacGillivray
David F. Torchiana
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Ann Thorac Surg 2005;80:570-577
© 2005 The Society of Thoracic Surgeons

Original article: Cardiovascular

Long-Term Survival After Surgical Revascularization for Moderate Ischemic Mitral Regurgitation

Daniel R. Wong, MD, MPH a , b , Arvind K. Agnihotri, MD a , Judy W. Hung, MD c , Gus J. Vlahakes, MD a , Cary W. Akins, MD a , Alan D. Hilgenberg, MD a , Joren C. Madsen, MD, DPhil a , Thomas E. MacGillivray, MD a , Michael H. Picard, MD c , David F. Torchiana, MD a , *

a Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
c Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
b Maritime Heart Centre, Halifax, Nova Scotia, Canada

Accepted for publication March 7, 2005.

* Address reprint requests to Dr Torchiana, Division of Cardiac Surgery, Massachusetts General Hospital, 55 Fruit St, BUL 209, Boston, MA02114 (Email: torchiana.david{at}mgh.harvard.edu).

BACKGROUND: We sought to characterize patient survival and degree of late mitral regurgitation (MR) in patients undergoing surgical revascularization with moderate ischemic MR.

METHODS: We retrospectively reviewed 251 patients undergoing coronary artery bypass graft (CABG) surgery between 1991 and 2001 with 3+ ischemic MR, including 31 patients who had concomitant mitral annuloplasty. Univariate and multivariable testing was employed.

RESULTS: Actuarial 1-, 5-, and 10-year survival was 84.0%, 67.5%, and 37.1% in the overall group of 251 patients. Independent predictors of long-term mortality were age 70 years or more (hazard ratio 2.50 [95% confidence interval 1.82 to 3.44]), prior myocardial infarction (3.99 [2.15 to 7.39]), unstable angina (2.27 [1.69 to 3.04]), chronic renal failure (4.87 [3.13 to 7.58]), atrial fibrillation (2.21 [1.65 to 2.96]), left internal mammary artery to left anterior descending artery graft (0.28 [0.18 to 0.43]), preoperative ß-blocker (0.43 [0.28 to 0.67]), ejection fraction (0.71/10% [0.64 to 0.80]), left atrium size (0.88/mm [0.84 to 0.92]), diffuse wall motion abnormalities (2.83 [1.77 to 4.55]), and mitral leaflet restriction (3.85 [2.46 to 5.99]). The model controlled for the performance of annuloplasty, which did not emerge as an independent predictor. Patients undergoing annuloplasty did have less mean late MR than those having CABG alone (p = 0.005). Overall, 57.8% of patients (63 of 109) with follow-up echocardiograms had improvement in grade of MR compared with baseline. In 54 of 95 patients (56.8%), intraoperative transesophageal echocardiography downgraded the degree of MR compared with the preoperative study.

CONCLUSIONS: Patients with moderate ischemic MR undergoing CABG had relatively poor long-term survival, with significant differences when stratified according to preoperative characteristics. Performance of mitral annuloplasty reduced the degree of regurgitation but was not a predictor of long-term survival. Intraoperative transesophageal echocardiography frequently downgraded the degree of MR.




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