Original articleAdult cardiacSurvival Prognosis and Surgical Management of Ischemic Mitral Regurgitation
Section snippets
Material and Methods
Institutional Review Board permission was obtained for this study and individual patient consent was waived. The Duke Cardiovascular Disease Databank identified all patients with coronary artery disease who underwent surgical therapy from January 1, 1986, through December 31, 2006. Patients having procedures concomitant with CABG, but not related to IMR, were excluded (aortic valve, tricuspid valve, or MV operations for nonischemic etiologies, repair of postinfarct ventricular septal defect or
Results
Baseline characteristics for the 19,912 patients in group 1 and group 2 are shown in Table 1. Patients with IMR (group 2) demonstrated worse preoperative risk factor profiles than group 1. Specific adverse factors in group 2 included greater age, hyperlipidemia, diabetes, hypertension and renal insufficiency, as well as higher heart failure class, EF reduction, and myocardial infarction history. More female patients existed in group 2, suggesting that IMR disproportionately affected women.
Comment
A high incidence of preoperative risk factors is characteristic of IMR, and these factors influence survival significantly. When differences in baseline characteristics were adjusted statistically, the adverse risk profile of IMR seemed be a major factor limiting survival in IMR, accounting for much of the 58% 5-year survival of IMR patients after repair. Thus, CABG-only patients with the same risk profiles as IMR would have similarly reduced survival, because advanced age and adverse cardiac
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Authors contributed equally.