BACKGROUND:
The optimum treatment for moderate ischemic mitral regurgitation during surgical revascularization is controversial.
METHODS:
We retrospectively reviewed 251 CABG patients from 1991-2001 with 3+ ischemic MR pre-operatively; only 31 had concomitant mitral annuloplasty.
RESULTS:
Prevalence of baseline comorbidities was high, with no difference between CABG and CABG+annuloplasty patients. Hospital mortality was 5.2% with median LOS 7 days. Actuarial 1-, 5- and 10-year survival was 84.0%, 67.5% and 37.1%. Using bootstrapped, multi-phase parametric survival analysis, past MI (p=0.02), chronic renal failure (CRF; p=0.0003), global LV dysfunction (p=0.03), and restricted MV motion (p=0.002) independently predicted early-phase death (<1 yr); LIMA to LAD graft (p=0.004), pre-op beta-blocker (p=0.04), and larger LA size (p=0.003) were protective. Late-phase mortality was associated with age 70+ (p=0.005), AFib (p=0.007), unstable angina (p=0.006), and low EF (p=0.003). Propensity-balanced survival was similar (p=0.80) with and without annuloplasty with Cox modeling, despite greater residual MR in CABG only patients (p=0.047). Compared to annuloplasty patients, isolated CABG patients downgraded the degree of MR more often on intraoperative TEE (p=0.0001); progression of their MR was associated with larger LA size, CRF, and a trend to inferior dysfunction.
CONCLUSIONS:
Patients with moderate ischemic MR have consistently poor long-term outcomes. At the time of CABG, concomitant annuloplasty does not appear to reduce late mortality. Ventricular function and patient comorbidities do influence survival critically.

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