Mitral surgery for ischemic mitral regurgitation does not improve long-term survival

We compared long-term survival in three cohorts of patients with known ischemic mitral regurgitation (MR). The cohorts consisted of (a) patients undergoing coronary bypass (CABG) with uncorrected mitral regurgitation (CABG+norep), (b) CABG and mitral repair (CABG+mrep) and (c) CABG and mitral replacement (CABG+mrepl). We found that overall, there was a poorer survival in patients undergoing mitral repair and replacement. When matched and stratified according to the severity of mitral regurgitation, mitral surgery did not improve survival in mild, moderate or severe regurgitation. We conclude that mitral valve surgery does not improve survival in patients with ischemic mitral regurgitation. These data may be explained by patient selection bias or the concept that the dominant pathology in ischemic mitral regurgitation is the ischemia, not the mitral valve abnormality.