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Ann Thorac Surg 2005;80:811-819
© 2005 The Society of Thoracic Surgeons

Original article: Cardiovascular

Ischemic Versus Degenerative Mitral Regurgitation: Does Etiology Affect Survival?

A. Marc Gillinov, MD a , * , Eugene H. Blackstone, MD a , b , Jeevanantham Rajeswaran, MS b , Maurice Mawad, MD a , Patrick M. McCarthy, MD a , Joseph F. Sabik, III, MD a , Takahiro Shiota, MD c , Bruce W. Lytle, MD a , Delos M. Cosgrove, MD a

a Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
b Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio
c Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio

Accepted for publication March 16, 2005.

* Address reprint requests to Dr Gillinov, The Cleveland Clinic Foundation, 9500 Euclid Avenue / Desk F24, Cleveland, OH 44195 (Email: gillinom{at}ccf.org).

Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.

BACKGROUND: Ischemic mitral regurgitation (MR) is associated with poor survival and degenerative MR with excellent survival. We hypothesized that in some patients with degenerative MR requiring concomitant coronary artery bypass grafting (CABG), ischemic disease would dominate prognosis, resulting in survival as poor as in patients with ischemic MR. Thus, we (1) determined survival impact of etiology (degenerative vs ischemic) after combined mitral valve repair and CABG and (2) explored survival differences within etiology groups.

METHODS: From 1985 to 2003, 710 patients underwent mitral valve repair for degenerative MR and concomitant CABG (two diseases); 400 patients had mitral annuloplasty and CABG for functional ischemic MR (one disease). Patients were propensity-matched on demography, symptoms, comorbidities, coronary artery disease, and left ventricular function. Survival was compared between matched groups and within groups.

RESULTS: Compared with patients with degenerative MR, those with ischemic MR had more extensive coronary artery disease, worse ventricular function, more comorbidities, and more symptoms (p < 0.05). Unadjusted 5-year survivals were 64% and 82% for patients with ischemic and degenerative MR, respectively. However, 123 ischemic and degenerative MR matched pairs had equivalently poor 5-year survival (p > 0.9), 66% and 65%, respectively. Among patients with degenerative MR, survival varied widely, depending largely on ischemic burden and extent of left ventricular dysfunction.

CONCLUSIONS: The large survival discrepancy between patients with ischemic and degenerative MR is attributable to differences in patient profile, particularly extent of ischemic disease and left ventricular dysfunction. Thus, ischemic and degenerative MR patients with equivalent characteristics have equivalently poor survival.




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