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Repair of Ischemic Mitral Regurgitation During Coronary Artery Bypass Grafting: Good Outcomes With a Complex Disease
*Michael P Robich, *Lee Lucas, Robert Kramer, *Sebastian Jablonski, *Joshua Cowgill, *Marco Diaz
Maine Medical Center, Portland, ME
Background: Aim to evaluate long-term safety and efficacy outcomes in patients with ischemic mitral regurgitation (IMR) and multi-vessel coronary artery disease who underwent coronary artery bypass grafting (CABG) with and without mitral valve repair (MVR) at Maine Medical Center (MMC).
Design: Retrospective cohort study, median follow-up 5 years.
Setting: Single center, tertiary care hospital in Portland, ME.
Patients: All patients with IMR and multi-vessel coronary artery disease who were referred to MMC for surgical revascularization with or without simultaneous MVR between January 1, 2004 and December 31, 2009. Cohort includes 151 patients with mild IMR (1+ by echocardiogram); 121 with moderate IMR (2+); 124 with severe IMR (3+ and 4+).
Intervention: CABG with and without simultaneous MVR.
Main Outcome Measures: Primary outcome is mortality. Secondary outcomes include degree of mitral insufficiency, progression to severe IMR, and ejection fraction.
Results: 7% of patients with mild IMR, 53% with moderate IMR, and 93% with severe IMR underwent the dual procedure. All-cause mortality was 17% in mild IMR; 23% in moderate; 22% in severe. Post-operative progression to severe IMR was 1% in mild IMR; 6% in moderate; 4% in severe. Ejection fraction was similar across all groups. In moderate IMR there was a non-significant trend toward decreased mortality in those receiving CABG plus MVR.
Conclusions: Across the entire cohort, survival was similar between patients who underwent CABG alone and CABG plus MVR, despite the dual procedure group having higher degree IMR. CABG plus MVR can be performed safely with low perioperative mortality and low rates of IMR recurrence; furthermore, both long-term mortality and rates of progression to severe IMR are low at MMC relative to previously published literature.
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