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Eur J Cardiothorac Surg 2001;20:270-275
© 2001 Elsevier Science NL

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

Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, G-52074 Aachen, Germany

Received 12 February 2001; received in revised form 10 May 2001; accepted 17 May 2001.

Corresponding author. Tel.: +49-241-8089957; fax: +49-241-88888454
e-mail: rseipelt{at}post.klinikum.rwth-aachen.de

Objectives: Mitral valve combined with coronary artery surgery is associated with a higher hospital mortality than each operation in particular. Controversy exists regarding the predictive value of ischemic mitral valve disease (MVD) on outcome. Methods: Between 1984 and 1997, 262 patients underwent mitral valve operations (replacement, n=198; repair, n=64) in combination with coronary revascularization. The etiology of MVD was secondary to ischemic heart disease (group I) in 82 (31%) patients, and non-ischemic (group II) in 180 (69%) patients (rheumatic, 139 patients (53%); degenerative, 41 patients (16%)). Both groups were similar in age, cardiac risk factors and pulmonary artery pressure. Patients of group I had significantly more severe coronary artery disease, more often an impaired left ventricle and myocardial infarction, and were in a worse functional condition. The mean number 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 significantly 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 early outcome, although mitral valve repair was performed more often in group I (37 versus 19%). The survival (valve-related event-free survival) after discharge from hospital in the 1st, 5th and 10th 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: Patients with ischemic MVD are in a worse cardiac condition with significantly higher hospital mortality than patients with non-ischemic MVD and coronary artery bypass grafting. Once discharged from hospital, both groups have comparable long-term outcomes, with the best results in patients with degenerative MVD.

Key Words: Mitral valve • Ischemic mitral regurgitation • Ischemic heart disease • Coronary artery bypass surgery

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