Abstract
Mortality and its determinants were assessed in 181 consecutive patients undergoing primary mitral valve surgery for pure mitral regurgitation with coronary artery disease (MR + CAD, 79 patients) or without (MR no CAD, 102 patients). Early mortality (C10% vs. 3%) and 6-year estimate of survival (55% +/- 7.1% vs. 82% +/- 4.4%) were significantly different. Mortality was not significantly different in patients with CAD + MR of an ischemic (49 patients) or a non-ischemic etiology (30 patients). Multivariate testing using Cox regression models of overall mortality in patients with MR + CAD indicated that preoperative renal dysfunction, high right atrial pressure, ejection fraction less than 45% as well as qualitatively reduced left ventricular function and left ventricular end-diastolic volume index greater than 120 ml/m2 are associated with decreased survival. Multivariate testing in patients with MR no CAD only identified insertion of a mechanical prosthesis and a degenerative etiology of mitral valve disease as independent predictors of survival. Thus, a common denominator of preoperative pathology (renal dysfunction) and indices of right and left ventricular dysfunction determined overall survival of patients with MR + CAD. Survival of patients with MR no CAD was determined by the valve prosthesis and the etiology of valve disease.
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