{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T07:18:51Z","timestamp":1781939931774,"version":"3.54.5"},"reference-count":19,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T00:00:00Z","timestamp":1752019200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Coronary heart disease (CHD) remains the most prevalent pathology within the circulatory system. Among its chronic complications, ischemic mitral valve regurgitation (IMR) is observed in approximately 15% of patients with sustained myocardial ischemia. The presence of this complex valvular defect significantly increases both overall mortality and the incidence of adverse cardiovascular events. Notably, the presence of moderate to severe mitral regurgitation in patients undergoing surgical revascularization has been shown to double the risk of death. Despite the well-established etiology of IMR, data regarding the efficacy of surgical interventions and the determinants of postoperative outcomes remain inconclusive. Methods: The objective of the present study was to evaluate both early and long-term outcomes of surgical treatment of mitral regurgitation in patients undergoing coronary artery bypass grafting (CABG) due to ischemic heart disease. Particular attention was given to the influence of the severity of regurgitation, left ventricular ejection fraction (LVEF), and the dimensions of the left atrium (LA) and left ventricle (LV) on the postoperative prognosis. An additional aim was to identify preoperative risk factors associated with increased postoperative mortality and morbidity. A retrospective analysis was conducted on 421 patients diagnosed with ischemic mitral regurgitation who underwent concomitant mitral valve surgery and CABG. Exclusion criteria included emergent and urgent procedures as well as non-ischemic etiologies of mitral valve dysfunction. Results: The study cohort comprised 34.9% women and 65.1% men, with the mean age of 65.7 years (\u00b17.57). A substantial proportion (76.7%) of patients were aged over 60 years. More than half (51.5%) presented with severe heart failure symptoms, classified as NYHA class III or IV, while over 70% were categorized as CCS class II or III. Among the surgical procedures performed, 344 patients underwent mitral valve repair, and 77 patients required mitral valve replacement. Additionally, 119 individuals underwent concomitant tricuspid valve repair. Short-term survival was significantly affected by the presence of hypertension, prior cerebrovascular events, and chronic kidney disease. In contrast, hypertension and chronic obstructive pulmonary disease were identified as significant predictors of adverse late-term outcomes. Conclusions: Interestingly, neither the preoperative severity of mitral regurgitation nor the echocardiographic measurements of LA and LV dimensions were found to significantly influence surgical outcomes. The perioperative risk, as assessed by the EuroSCORE II (average score: 10.0%), corresponded closely with observed mortality rates following mitral valve repair (9.9%) and replacement (10.4%). Notably, the need for concomitant tricuspid valve surgery was associated with an elevated mortality rate (12.4%). Furthermore, the preoperative echocardiographic evaluation of LA regurgitation severity, as well as LA and LV dimensions, did not exhibit a statistically significant impact on either early or long-term surgical outcomes. However, a reduced LVEF was correlated with increased long-term mortality. The presence of advanced clinical symptoms and the necessity for tricuspid valve repair were independently associated with a poorer late-term prognosis. Importantly, the annual mortality rate observed in the late-term follow-up of patients who underwent surgical treatment of ischemic mitral regurgitation was lower than rates reported in the literature for patients managed conservatively. The EuroSCORE II scale proved to be a reliable and precise tool in predicting surgical risk and outcomes in this patient population.<\/jats:p>","DOI":"10.3390\/jcm14144855","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T10:26:53Z","timestamp":1752229613000},"page":"4855","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Ischemic Mitral Valve Regurgitation in Patients Undergoing Coronary Artery Bypass Grafting\u2014Early and Late-Term Outcomes of Surgical Treatment"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1516-4043","authenticated-orcid":false,"given":"Pawe\u0142","family":"Walerowicz","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Pomeranian Medical University, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4621-5907","authenticated-orcid":false,"given":"Miros\u0142aw","family":"Brykczy\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, 65-046 Zielona Gora, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6105-5329","authenticated-orcid":false,"given":"Aleksandra","family":"Szyli\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Pomeranian Medical University, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8484-0899","authenticated-orcid":false,"given":"Jerzy","family":"Pacholewicz","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Pomeranian Medical University, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,9]]},"reference":[{"key":"ref_1","first-page":"67","article-title":"Przewlek\u0142a niedokrwienna niedomykalno\u015b\u0107 zastawki mitralnej. Cz\u0119\u015b\u0107 I: Epidemiologia, patogeneza, diagnostyka","volume":"69","author":"Siminiak","year":"2011","journal-title":"Kardiol. Polska"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1007\/s11886-011-0241-y","article-title":"Ischemic mitral regurgitation: Not only a bystander","volume":"14","author":"Unger","year":"2012","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_3","first-page":"1226","article-title":"The impact of preoperative left ventricular ejection fraction on short- and mid-term outcomes in ischemic mitral valve repair","volume":"68","author":"Sasmazel","year":"2010","journal-title":"Kardiol. Polska"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1177\/145749691110000209","article-title":"Impact of coronary artery bypass surgery on ischemic mitral regurgitation","volume":"100","author":"Mustonen","year":"2011","journal-title":"Scand. J. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1161\/01.CIR.44.2.174","article-title":"Combined papillary muscle and left ventricular wall dysfunction as a cause of mitral regurgitation: An experimental study","volume":"44","author":"Mittal","year":"1971","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1161\/01.CIR.0000138196.06772.4e","article-title":"Restrictive annuloplasty and coronary revascularization in ischemic mitral regurgitation: Results in reverse left ventricular remodeling","volume":"110","author":"Bax","year":"2004","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1136\/heart.87.1.79","article-title":"Timing of mitral valve surgery","volume":"87","year":"2002","journal-title":"Heart"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"18","DOI":"10.7326\/0003-4819-117-1-18","article-title":"Outcome of patients sustaining acute ischemic mitral regurgitation during myocardial infarction","volume":"117","author":"Tcheng","year":"1992","journal-title":"Ann. Intern. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.1016\/j.jacc.2007.02.043","article-title":"Impact of mitral valve annuloplasty combined with revascularization in patients with functional mitral regurgitation","volume":"49","author":"Mihaljevic","year":"2007","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.3346\/jkms.2011.26.12.1582","article-title":"Using a vascular strip for ischemic mitral regurgitation: Ten years of experience at a single center","volume":"26","author":"Jeong","year":"2011","journal-title":"J. Korean Med. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1016\/j.ejcts.2004.07.049","article-title":"Ischemic mitral valve prolapse: Mechanisms and implications for valve repair","volume":"26","author":"Jouan","year":"2004","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/S0002-9149(02)03301-5","article-title":"Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure","volume":"91","author":"Trichon","year":"2003","journal-title":"Am. J. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1161\/CIRCULATIONAHA.104.486720","article-title":"Ischemic mitral regurgitation on the threshold of a solution: From paradoxes to unifying concepts","volume":"112","author":"Levine","year":"2005","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2639","DOI":"10.1161\/CIRCULATIONAHA.111.072256","article-title":"Influence of mitral regurgitation repair on survival in the surgical treatment for ischemic heart failure trial","volume":"125","author":"Deja","year":"2012","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1016\/j.jacc.2005.08.077","article-title":"Prediction of cardiovascular outcomes with left atrial size: Is volume superior to area or diameter?","volume":"47","author":"Tsang","year":"2006","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1016\/j.echo.2015.07.004","article-title":"Predictive value of left atrial deformation on prognosis in severe primary mitral regurgitation","volume":"28","author":"Yang","year":"2015","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"172","DOI":"10.5455\/aim.2016.24.172-177","article-title":"Echocardiographic assessment of ischemic mitral regurgitation: Mechanism, severity, impact on treatment strategy, and long-term outcome","volume":"24","author":"Naser","year":"2016","journal-title":"Acta Inform. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2930","DOI":"10.1053\/j.jvca.2019.04.028","article-title":"Outcome prediction after coronary surgery and redo surgery for bleeding (from the KROK Registry)","volume":"33","author":"Knapik","year":"2019","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3738","DOI":"10.1161\/CIRCULATIONAHA.105.561423","article-title":"Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients","volume":"112","author":"Solomon","year":"2005","journal-title":"Circulation"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/4855\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:06:55Z","timestamp":1760033215000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/4855"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,9]]},"references-count":19,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14144855"],"URL":"https:\/\/doi.org\/10.3390\/jcm14144855","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,9]]}}}