Myocardial revascularization and mitral repair or replacement for mitral insufficiency due to coronary artery disease.

During the past 5 years, 45 patients were operated on for mitral insufficiency due to coronary artery disease. Preoperatively, 33 had angina; 24 were in NYHA Class IV; and 21 were in Class III. The ejection fraction ranged from 0.1 to 0.7 (mean 0.40). The degree of mitral regurgitation ranged from Grade II/VI to Grade V/VI. Mitral repair was performed in 38 (84%) and replacement in seven (16%). At surgery, a ruptured papillary muscle or torn chordae tendineae with a dilated annulus were found in 21 patients and a dilated annulus only in 24. Seventy-six vein grafts and eight internal mammary anastomoses were performed. There were three hospital deaths (7%). Postoperative follow-up of 36 long-term survivors revealed symptomatic improvement in all but one patient. Twenty patients were in NYHA Class I, 15 in Class II, and one in Class III. In eight patients restudied, 17 of 18 vein grafts were patent (94%). Mitral regurgitation decreased from a mean of 2.7 to a mean of 0.6 (P less than 0.001). Average improvement in ejection fraction was 0.14, significant at P less than 0.01. Actuarial studies revealed an 80% survival rate at 5 years.