Determinants of survival after surgery for mitral valve regurgitation in patients with and without coronary artery disease

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.