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Mitral regurgitation surgery in patients with ischemic cardiomyopathy and ischemic mitral regurgitation: factors that influence survival.
J Thorac Cardiovasc Surg 2011; 142(5):995-1001JT

Abstract

OBJECTIVE

The treatment of patients with ischemic cardiomyopathy and concomitant mitral regurgitation can be challenging and is associated with reduced long-term survival. It is unclear how mitral valve repair versus replacement affects subsequent outcome. Therefore, we conducted this study to understand the predictors of mortality and to delineate the role of mitral valve repair versus replacement in this high-risk population.

METHODS

From 1993 to 2007, 431 patients (mean age, 70 ± 9 years) with ischemic cardiomyopathy (left ventricular ejection fraction ≤ 45%) and significant ischemic mitral regurgitation (>2) were identified. Patients (44) with concomitant mitral stenosis were excluded from the analysis. A homogeneous group of 387 patients underwent combined coronary artery bypass grafting and mitral valve surgery, mitral valve repair in 302 (78%) and mitral valve replacement in 85 (22%). Uni- and multivariate analyses were performed on the entire cohort, and the predictors of mortality were identified in 2 distinct risk phases. Furthermore, we specifically examined the impact of mitral valve repair versus replacement by comparing 2 propensity-matched subgroups.

RESULTS

Follow-up was 100% complete (median, 3.6 years; range, 0-15 years). Overall 1-, 5-, and 10-year survivals were 82.7%, 55.2%, and 24.3%, respectively, for the entire group. The risk factors for an increased mortality within the first year of surgery included previous coronary artery bypass grafting (hazard ratio = 3.39; P < .001), emergency/urgent status (hazard ratio = 2.08; P = .007), age (hazard ratio = 1.5; P = .03), and low left ventricular ejection fraction (hazard ratio = 1.31; P = .026). Thereafter, only age (hazard ratio = 1.58; P < .001), diabetes (hazard ratio = 2.5; P = .001), and preoperative renal insufficiency (hazard ratio = 1.72; P = .025) were predictive. The status of mitral valve repair versus replacement did not influence survival, and this was confirmed by comparable survival in propensity-matched analyses.

CONCLUSIONS

Survival after combined coronary artery bypass grafting and mitral valve surgery in patients with ischemic cardiomyopathy (left ventricular ejection fraction ≤ 45%) and mitral regurgitation is compromised and mostly influenced by factors related to the patient's condition at the time of surgery. The specifics of mitral valve repair versus replacement did not seem to affect survival.

Authors+Show Affiliations

Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21855899

Citation

Maltais, Simon, et al. "Mitral Regurgitation Surgery in Patients With Ischemic Cardiomyopathy and Ischemic Mitral Regurgitation: Factors That Influence Survival." The Journal of Thoracic and Cardiovascular Surgery, vol. 142, no. 5, 2011, pp. 995-1001.
Maltais S, Schaff HV, Daly RC, et al. Mitral regurgitation surgery in patients with ischemic cardiomyopathy and ischemic mitral regurgitation: factors that influence survival. J Thorac Cardiovasc Surg. 2011;142(5):995-1001.
Maltais, S., Schaff, H. V., Daly, R. C., Suri, R. M., Dearani, J. A., Sundt, T. M., ... Park, S. J. (2011). Mitral regurgitation surgery in patients with ischemic cardiomyopathy and ischemic mitral regurgitation: factors that influence survival. The Journal of Thoracic and Cardiovascular Surgery, 142(5), pp. 995-1001. doi:10.1016/j.jtcvs.2011.07.044.
Maltais S, et al. Mitral Regurgitation Surgery in Patients With Ischemic Cardiomyopathy and Ischemic Mitral Regurgitation: Factors That Influence Survival. J Thorac Cardiovasc Surg. 2011;142(5):995-1001. PubMed PMID: 21855899.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mitral regurgitation surgery in patients with ischemic cardiomyopathy and ischemic mitral regurgitation: factors that influence survival. AU - Maltais,Simon, AU - Schaff,Hartzell V, AU - Daly,Richard C, AU - Suri,Rakesh M, AU - Dearani,Joseph A, AU - Sundt,Thoralf M,3rd AU - Enriquez-Sarano,Maurice, AU - Topilsky,Yan, AU - Park,Soon J, Y1 - 2011/08/19/ PY - 2011/04/08/received PY - 2011/06/21/revised PY - 2011/07/20/accepted PY - 2011/8/23/entrez PY - 2011/8/23/pubmed PY - 2011/12/13/medline SP - 995 EP - 1001 JF - The Journal of thoracic and cardiovascular surgery JO - J. Thorac. Cardiovasc. Surg. VL - 142 IS - 5 N2 - OBJECTIVE: The treatment of patients with ischemic cardiomyopathy and concomitant mitral regurgitation can be challenging and is associated with reduced long-term survival. It is unclear how mitral valve repair versus replacement affects subsequent outcome. Therefore, we conducted this study to understand the predictors of mortality and to delineate the role of mitral valve repair versus replacement in this high-risk population. METHODS: From 1993 to 2007, 431 patients (mean age, 70 ± 9 years) with ischemic cardiomyopathy (left ventricular ejection fraction ≤ 45%) and significant ischemic mitral regurgitation (>2) were identified. Patients (44) with concomitant mitral stenosis were excluded from the analysis. A homogeneous group of 387 patients underwent combined coronary artery bypass grafting and mitral valve surgery, mitral valve repair in 302 (78%) and mitral valve replacement in 85 (22%). Uni- and multivariate analyses were performed on the entire cohort, and the predictors of mortality were identified in 2 distinct risk phases. Furthermore, we specifically examined the impact of mitral valve repair versus replacement by comparing 2 propensity-matched subgroups. RESULTS: Follow-up was 100% complete (median, 3.6 years; range, 0-15 years). Overall 1-, 5-, and 10-year survivals were 82.7%, 55.2%, and 24.3%, respectively, for the entire group. The risk factors for an increased mortality within the first year of surgery included previous coronary artery bypass grafting (hazard ratio = 3.39; P < .001), emergency/urgent status (hazard ratio = 2.08; P = .007), age (hazard ratio = 1.5; P = .03), and low left ventricular ejection fraction (hazard ratio = 1.31; P = .026). Thereafter, only age (hazard ratio = 1.58; P < .001), diabetes (hazard ratio = 2.5; P = .001), and preoperative renal insufficiency (hazard ratio = 1.72; P = .025) were predictive. The status of mitral valve repair versus replacement did not influence survival, and this was confirmed by comparable survival in propensity-matched analyses. CONCLUSIONS: Survival after combined coronary artery bypass grafting and mitral valve surgery in patients with ischemic cardiomyopathy (left ventricular ejection fraction ≤ 45%) and mitral regurgitation is compromised and mostly influenced by factors related to the patient's condition at the time of surgery. The specifics of mitral valve repair versus replacement did not seem to affect survival. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/21855899/Mitral_regurgitation_surgery_in_patients_with_ischemic_cardiomyopathy_and_ischemic_mitral_regurgitation:_factors_that_influence_survival_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(11)00779-3 DB - PRIME DP - Unbound Medicine ER -