Combined mitral valve and coronary artery surgery: ischemic versus non-ischemic mitral valve disease

Objectives: Mitral valve combined with coronary artery surgery is associate d with a higher hospital mortality than each operation in particular. Contr oversy exists regarding the predictive value of ischemic mitral valve disea se (MVD) on outcome. Methods: Between 1984 and 1997, 262 patients underwent mitral valve operations (replacement, n = 198; repair, n = 64) in combinat ion with coronary revascularization. The etiology of MVD was secondary to i schemic heart disease (group I) in 82 (31%) patients, and non-ischemic (gro up II) in 180 (69%) patients (rheumatic, 139 patients (53%); degenerative, 41 patients (16%)). Both groups were similar in age, cardiac risk factors a nd pulmonary artery pressure. Patients of group I had significantly more se vere coronary artery disease, more often an impaired left ventricle and myo cardial infarction, and were in a worse functional condition. The mean numb er of bypass grafts was significantly higher in group I. The follow-up was 98% (230/234 patients). Results: With 19.5%, the hospital mortality was sig nificantly increased in group I compared with 6.7% in group II (P = 0.002; overall, 10.7%). Mitral valve repair or replacement had no influence on ear ly outcome, although mitral valve repair was performed more often in group I (37 versus 19%). The survival (valve-related event-free survival) after d ischarge from hospital in the 1st, 5th and loth year was 94 (94%), 70 (66%) and 53% (35%) in group I and 96 (95%), 79 (76%) and 54% (41%) in group II, respectively.. The long-term functional capacity was equally good in both groups (New York Heart Association mean, 1.86 versus 1.72). Conclusions: Pa tients with ischemic MVD are in a worse cardiac condition with significantl y higher hospital mortality than patients with non-ischemic MVD and coronar y artery bypass grafting. Once discharged from hospital, both groups have c omparable long-term outcomes, with the best results in patients with degene rative MVD. (C) 2001 Elsevier Science B.V. All rights reserved.