Moderate-to-severe ischemic mitral regurgitation and multivessel coronary artery disease: Impact of different treatment on survival and rehospitalization

Background The outcome of moderate-to-severe ischemic mitral regurgitation with multivessel coronary artery disease is still debated. We analysed the effect of different treatments, i.e. medical therapy (MT), coronary artery by-pass grafting (CABG) alone and CABG with mitral valve surgery (MVS), on the survival and rehospitalization of these patients. Methods Between 1990 and 2002, we identified 111 consecutive patients, aged 73 ± 8 years, with chronic moderate-to-severe mitral regurgitation and multivessel coronary artery disease at cardiac catheterization, in absence of primary valve disease. Twenty-two patients were treated by MT, 50 by CABG and 39 by CABG + MVS. Overall, the median clinical and echocardiographic follow-ups were 34.9 and 14.6 months, respectively. Results Groups differed significantly (p < 0.03) for left ventricular end-diastolic volume index (MT 153 ± 54, CABG 125 ± 35, CABG + MVS 129 ± 38, ml/m2), ejection fraction (MT 35 ± 14, CABG 38 ± 13, CABG + MVS 50 ± 14, %) and mammary artery graft use (CABG 60, CABG + MVS 74, %). While in-hospital mortality was higher in surgical patients (MT 13.6, CABG 18, CABG + MVS 17.9, %, p = 0.09), 7-years mortality showed a trend in favour of CABG + MVS compared to other groups (MT 100, CABG 57, CABG + MVS 29, %, p = 0.1). After adjusting for baseline differences, CABG alone or with MVS had a 57% (HR 0.43, p = 0.005) and 53% (HR 0.47, p = 0.02) risk reduction of combined cardiac death and rehospitalization rate compared to MT. However, only CABG + MVS independently predicted mortality (risk reduction 65%, HR 0.35, p = 0.027). Conclusions In moderate-to-severe ischemic mitral regurgitation and multivessel coronary artery disease, surgery reduced total cardiac events but only a concomitant MVS significantly improved survival.