Ischemic mitral valve disease: classification and systemic approach to management.

One hundred sixty-nine consecutive patients with coronary artery disease and mitral valve pathology operated during the past 5 years were reviewed (98% follow-up). Eighty-seven patients underwent mitral valve repair and 82 mitral valve replacement with concomitant coronary artery bypass grafting (number of AV grafts = 3). An analysis of these patients (age range 48 to 92 [mean 69]) and a classification based on anatomic pathology of the mitral apparatus is presented. Flexible ring annuloplasty was utilized in all repairs and chordal-sparing techniques in all valve replacements. There was equal mortality for replacement and repair in this subset of high risk patients. Structural valve dysfunction of repaired valves was more common (5/81 [6.0]) than primary tissue valve failure after mitral valve replacement (0 patients).