Surgical revascularization is associated with maximal survival in patients with ischemic mitral regurgitation: a 20-year experience.

Background —The optimal treatment for ischemic mitral regurgitation (IMR) remains actively debated. Our objective was to evaluate the relationship between IMR treatment strategy and survival. Methods and Results —We retrospectively reviewed patients at our institution diagnosed with significant coronary artery disease and moderate or severe IMR from 1990-2009, categorized by medical treatment alone (MED), percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or CABG + mitral valve repair or replacement (MVRR). Kaplan-Meier methods and multivariable Cox proportional hazard analyses were performed to assess the relationship between treatment strategy and survival, using propensity scores to account for nonrandom treatment assignment. A total of 4,989 patients were included: MED = 36%, PCI = 26%, CABG = 33%, and CABG+MVRR = 5%. Median follow-up was 5.37 years. Compared to MED, significantly lower mortality was observed in patients treated with PCI [adjusted hazard ratio (AHR): 0.83, 95% confidence interval (CI): 0.76 - 0.92, p=0.0002], CABG (AHR: 0.56, CI: 0.51 - 0.62, p<0.0001), and CABG+MVRR (AHR: 0.69, CI: 0.57 - 0.82, p<0.0001). There was no significant difference in these results based on MR severity. Conclusions —Patients with significant coronary artery disease and moderate or severe IMR undergoing CABG alone demonstrated the lowest risk of death. CABG with or without mitral valve surgery was associated with lower mortality than either PCI or MED.