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The Journal of Thoracic and Cardiovascular Surgery, Vol 88, 663-672, Copyright © 1984 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
CW Pinson, A Cobanoglu, MT Metzdorff, GL Grunkemeier, PH Kay and A Starr
The indication for concomitant valve operations for ischemic mitral
regurgitation is examined in 120 consecutive patients with regurgitation
who had coronary bypass. Ischemic mitral regurgitation was mild in 56%,
moderate in 18%, and severe in 27%. Compared with patients without mitral
regurgitation who underwent coronary bypass, significantly more patients
with regurgitation had cardiomegaly (31% versus 5%), left heart failure
(42% versus 6%), and abnormal wall motion scores (71% versus 42%).
Eighty-three patients (69%) with ischemic mitral regurgitation had coronary
bypass alone and 37 (31%) also had a valve operation. All patients with
mild ischemic mitral regurgitation were treated by coronary bypass alone,
as compared to 67% with moderate and 6% with severe regurgitation.
Operative mortalities for mild, moderate, and severe ischemic mitral
regurgitation were 4%, 10%, and 38%, respectively; 5 year survival rates
were 82%, 60%, and 48%, respectively. Other significant determinants of
survival were wall motion score, shock, cardiomegaly, left heart failure,
and acute and multiple myocardial infarctions. Patients with mild ischemic
mitral regurgitation and a low wall motion score (n = 40) had a 5 year
survival rate of 94%. For patients with either moderate/severe
regurgitation (n = 27) or a high wall motion score (n = 25), but not both,
the 5 year survival rate was 70%. In 20 patients with both a high wall
motion score and moderate/severe regurgitation, it was 33%. An additive
detrimental effect is apparent. The change from mild to moderate/severe
ischemic mitral regurgitation was equivalent to an increase of about 8 wall
motion score units in terms of effect on survival. Ischemic mitral
regurgitation is a powerful additive risk factor to wall motion score in
coronary bypass. Mild regurgitation is best managed by coronary bypass
alone. If regurgitation is moderate, it may still be possible to avoid a
valve operation and have acceptable results. Severe ischemic mitral
regurgitation usually necessitates coronary bypass and a mitral valve
operation.
ARTICLES
Late surgical results for ischemic mitral regurgitation. Role of wall motion score and severity of regurgitation
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