Treatment of moderate mitral regurgitation and coronary disease by coronary bypass alone: Late results

Background. In cases of moderate mitral regurgitation and coronary artery d isease operative strategy continues to be debated between coronary artery b ypass grafting alone and concomitant valve replacement or repair. We previo usly reported on 58 patients with moderate mitral regurgitation who had cor onary artery bypass grafting between 1977 and 1983. We present the late res ults for this original cohort (test group), and a matched control group of coronary artery bypass grafting patients without mitral regurgitation (n = 58). Methods and Results. In the original cohort, the hospital mortality rate wa s 3.4% (2 of 58), and 80.4% (45 of 56) of hospital survivors were alive at the time of initial follow-up (mean, 4.3 +/- 2.3 years). Hospital mortality in the control group was 6.9% (4 of 58 patients). Follow-up was 98.2% (108 of 110 patients) complete, with a mean follow-up time of 10.3 +/- 5.5 year s. Kaplan-Meier curves for hospital survivors showed similar 5- and 10-year survival rates between the two groups (p = 0.59). On multivariate analysis , age 65 years or more, congestive heart failure class III or IV, and pulmo nary capillary wedge pressure more than 17 mm Hg were significant (p < 0.05 ) independent predictors of diminished survival in the test group. Conclusions. Patients with moderate mitral regurgitation and coronary arter y disease treated solely with coronary artery bypass grafting had acceptabl e early and late results. Moderate mitral regurgitation at the time of reva scularization does not always warrant operative correction. (C) 1999 by The Society of Thoracic Surgeons.