Circulation, Vol 90, 830-837, Copyright © 1994 by American Heart Association
M Enriquez-Sarano, AJ Tajik, HV Schaff, TA Orszulak, KR Bailey and RL Frye
BACKGROUND: Left ventricular dysfunction is a frequent cause of death after
successful surgical repair of mitral regurgitation. The role of
preoperative echocardiographic left ventricular variables in the prediction
of postoperative survival and thus their clinical implications remain
uncertain. METHODS AND RESULTS: The survival of 409 patients operated on
between 1980 and 1989 for pure, isolated, organic mitral regurgitation and
with a preoperative echocardiogram (within 6 months of operation) was
analyzed. The overall survival was 75% at 5 years (90% of expected), 58% at
10 years (88% of expected), and 44% at 12 years (73% of expected).
Operative mortality was 6.6% and markedly improved from 1980 to 1984
(10.7%) to 1985 to 1989 (3.7%). Multivariate analysis showed that age (P =
.0003), date of operation (P = .003), and functional class (P = .016) but
not left ventricular function were predictors of operative mortality. In
the most recent period (1985 to 1989), operative mortality was 12.3% in
patients age 75 years or older and 1.1% in patients younger than 75 years.
Late survival was analyzed in the operative survivors. Multivariate
analysis showed that the most powerful predictor was echocardiographic
ejection fraction (EF) (P = .0004), followed by age (P = .0031), creatinine
level (P = .0062), systolic blood pressure (P = .0164), and presence of
coronary artery disease (P = .0237). The late survival at 10 years was 32
+/- 12% for patients with EF < 50%, 53 +/- 9% for EF 50% to 60%, and 72
+/- 4% for EF > or = 60%. The hazard ratio compared with EF > or =
60% was 2.79 (95% confidence interval, 1.65 to 4.72) for EF < 50% and
1.81 (95% confidence interval, 1.11 to 2.95) for EF 50% to 60%.
Echocardiographic EF remained the best predictor of late survival, even
when combined with left ventricular angiographic variables. The survival of
patients with EF > or = 60% was 100% of expected at 10 years but was
better in patients in class I or II than in those in class III or IV (82
+/- 6% versus 59 +/- 6%, respectively, at 10 years; P = .0021). The
preoperative predictors of operative and late mortality remained
significant independent of the type of surgical correction performed in
combined multivariate analyses. CONCLUSIONS: In organic mitral
regurgitation, (1) operative mortality has markedly decreased recently,
being at a low 1.1% in patients younger than 75 years, and is predicted by
age and symptoms and not by left ventricular function, and (2) left
ventricular EF measured by echocardiography is the most powerful predictor
of late survival. These results suggest that surgical treatment should be
considered early, even in the absence of severe symptoms, in patients with
severe mitral regurgitation, before left ventricular dysfunction occurs.
ARTICLES
Echocardiographic prediction of survival after surgical correction of organic mitral regurgitation
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
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E. Lim, C. W. Barlow, A. R. Hosseinpour, C. Wisbey, K. Wilson, W. Pidgeon, S. Charman, J. B. Barlow, and F. C. Wells Influence of Atrial Fibrillation on Outcome Following Mitral Valve Repair Circulation, September 18, 2001; 104 (2009): I-59 - I-63. [Abstract] [Full Text] [PDF]
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H. L. Thomson, A.-J. Basmadjian, A. J. Rainbird, M. Razavi, J.-F. Avierinos, P. A. Pellikka, K. R. Bailey, J. F. Breen, and M. Enriquez-Sarano Contrast echocardiography improves the accuracy and reproducibility of left ventricular remodeling measurements: A prospective, randomly assigned, blinded study J. Am. Coll. Cardiol., September 1, 2001; 38(3): 867 - 875. [Abstract] [Full Text] [PDF]
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S. Kaji, P. C. Yang, A. B. Kerr, W. H. W. Tang, C. H. Meyer, A. Macovski, J. M. Pauly, D. G. Nishimura, and B. S. Hu Rapid evaluation of left ventricular volume and mass without breath-holding using real-time interactive cardiac magnetic resonance imaging system J. Am. Coll. Cardiol., August 1, 2001; 38(2): 527 - 533. [Abstract] [Full Text] [PDF]
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T. Le Tourneau, P. de Groote, A. Millaire, C. Foucher, C. Savoye, P. Pigny, A. Prat, H. Warembourg, and J. M. Lablanche Effect of mitral valve surgery on exercise capacity, ventricular ejection fraction and neurohormonal activation in patients with severe mitral regurgitation J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2263 - 2269. [Abstract] [Full Text] [PDF]
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H. M. Connolly, J. K. Oh, H. V. Schaff, V. L. Roger, S. L. Osborn, D. O. Hodge, and A. J. Tajik Severe Aortic Stenosis With Low Transvalvular Gradient and Severe Left Ventricular Dysfunction : Result of Aortic Valve Replacement in 52 Patients Circulation, April 25, 2000; 101(16): 1940 - 1946. [Abstract] [Full Text] [PDF]
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E. S. Bishay, P. M. McCarthy, D. M. Cosgrove, K. J. Hoercher, N. G. Smedira, D. Mukherjee, J. White, and E. H. Blackstone Mitral valve surgery in patients with severe left ventricular dysfunction Eur. J. Cardiothorac. Surg., March 1, 2000; 17(3): 213 - 221. [Abstract] [Full Text] [PDF]
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F. Grigioni, M. Enriquez-Sarano, L. H. Ling, K. R. Bailey, J. B. Seward, A. J. Tajik, and R. L. Frye Sudden death in mitral regurgitation due to flail leaflet J. Am. Coll. Cardiol., December 1, 1999; 34(7): 2078 - 2085. [Abstract] [Full Text] [PDF]
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B. A. Carabello Sudden death in mitral regurgitation: why was I so surprised? J. Am. Coll. Cardiol., December 1, 1999; 34(7): 2086 - 2087. [Full Text] [PDF]
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U. Izhar, R. C. Daly, J. A. Dearani, T. A. Orszulak, H. V. Schaff, and C. J. Mullany Mitral Valve Replacement or Repair After Previous Coronary Artery Bypass Grafting Circulation, November 9, 1999; 100 (2009): II-84 - II-89. [Abstract] [Full Text] [PDF]
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M. Enriquez-Sarano, W. K. Freeman, C. M. Tribouilloy, T. A. Orszulak, B. K. Khandheria, J. B. Seward, K. R. Bailey, and A. J. Tajik Functional anatomy of mitral regurgitation: Accuracy and outcome implications of transesophageal echocardiography J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1129 - 1136. [Abstract] [Full Text] [PDF]
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M. Enriquez-Sarano, A.-J. Basmadjian, A. Rossi, K. R. Bailey, J. B. Seward, and A. J. Tajik Progression of mitral regurgitation: A prospective Doppler echocardiographic study J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1137 - 1144. [Abstract] [Full Text] [PDF]
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R. C. Schlant Timing of Surgery for Patients With Nonischemic Severe Mitral Regurgitation Circulation, January 26, 1999; 99(3): 338 - 339. [Full Text] [PDF]
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C. M. Tribouilloy, M. Enriquez-Sarano, H. V. Schaff, T. A. Orszulak, K. R. Bailey, A. J. Tajik, and R. L. Frye Impact of Preoperative Symptoms on Survival After Surgical Correction of Organic Mitral Regurgitation : Rationale for Optimizing Surgical Indications Circulation, January 26, 1999; 99(3): 400 - 405. [Abstract] [Full Text] [PDF]
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A. Rossi, G. Golia, G. Gasparini, M. A. Prioli, M. Anselmi, and P. Zardini Left atrial filling volume can be used to reliably estimate the regurgitant volume in mitral regurgitation J. Am. Coll. Cardiol., January 1, 1999; 33(1): 212 - 217. [Abstract] [Full Text] [PDF]
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L. F. Camilleri, B. Miguel, P. Bailly, B. J. Legault, M.-C. D'Agrosa-Boiteux, G. L. Polvani, and C. M. de Riberolles Flexible posterior mitral annuloplasty: five-year clinical and Doppler echocardiographic results Ann. Thorac. Surg., November 1, 1998; 66(5): 1692 - 1697. [Abstract] [Full Text] [PDF]
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R. B.A. van den Brink, E. Dekker, H. A. Verheul, J. G.P. Tijssen, M. Enriquez-Sarano, and K. R. Bailey Effect of Age Adjustment in Predicting Outcome • Response Circulation, September 29, 1998; 98 (13): 1350 - 1353. [Full Text] [PDF]
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K. S. Dujardin, M. Enriquez-Sarano, K. R. Bailey, R. A. Nishimura, J. B. Seward, and A. J. Tajik Grading of Mitral Regurgitation by Quantitative Doppler Echocardiography : Calibration by Left Ventricular Angiography in Routine Clinical Practice Circulation, November 18, 1997; 96(10): 3409 - 3415. [Abstract] [Full Text]
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I. G. Duarte, C. O. Murphy, A. S. Kosinski, E. L. Jones, J. M. Craver, J. P. Gott, and R. A. Guyton Late Survival After Valve Operation in Patients With Left Ventricular Dysfunction Ann. Thorac. Surg., October 1, 1997; 64(4): 1089 - 1095. [Abstract] [Full Text]
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L. H. Ling, M. Enriquez-Sarano, J. B. Seward, T. A. Orszulak, H. V. Schaff, K. R. Bailey, A. J. Tajik, and R. L. Frye Early Surgery in Patients With Mitral Regurgitation Due to Flail Leaflets : A Long-term Outcome Study Circulation, September 16, 1997; 96(6): 1819 - 1825. [Abstract] [Full Text]
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 B. A. Carabello and F. A. Crawford Valvular Heart Disease N. Engl. J. Med., July 3, 1997; 337(1): 32 - 41. [Full Text] [PDF]
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H. M. Connolly, J. K. Oh, T. A. Orszulak, S. L. Osborn, V. L. Roger, D. O. Hodge, K. R. Bailey, J. B. Seward, and A. J. Tajik Aortic Valve Replacement for Aortic Stenosis With Severe Left Ventricular Dysfunction: Prognostic Indicators Circulation, May 20, 1997; 95(10): 2395 - 2400. [Abstract] [Full Text]
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M. D. Cheitlin, J. S. Alpert, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, T. W. Davidson, J. L. Davis, P. S. Douglas, L. D. Gillam, et al. ACC/AHA Guidelines for the Clinical Application of Echocardiography : A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography) Developed in Collaboration With the American Society of Echocardiography Circulation, March 18, 1997; 95(6): 1686 - 1744. [Full Text]
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L. H. Ling, M. Enriquez-Sarano, J. B. Seward, A. J. Tajik, H. V. Schaff, K. R. Bailey, and R. L. Frye Clinical Outcome of Mitral Regurgitation Due to Flail Leaflet N. Engl. J. Med., November 7, 1996; 335(19): 1417 - 1423. [Abstract] [Full Text] [PDF]
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E. M. Lee, L. M. Shapiro, and F. C. Wells Importance of Subvalvular Preservation and Early Operation in Mitral Valve Surgery Circulation, November 1, 1996; 94(9): 2117 - 2123. [Abstract] [Full Text]
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R. J. Cerfolio, T. A. Orszulak, J. R. Pluth, W. S. Harmsen, and H. V. Schaff REOPERATION AFTER VALVE REPAIR FOR MITRAL REGURGITATION: EARLY AND INTERMEDIATE RESULTS J. Thorac. Cardiovasc. Surg., June 1, 1996; 111(6): 1177 - 1184. [Abstract] [Full Text]
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M. Enriquez-Sarano, H. V. Schaff, T. A. Orszulak, K. R. Bailey, A. J. Tajik, and R. L. Frye Congestive Heart Failure After Surgical Correction of Mitral Regurgitation : A Long-term Study Circulation, November 1, 1995; 92(9): 2496 - 2503. [Abstract] [Full Text]
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M. R. Starling Effects of Valve Surgery on Left Ventricular Contractile Function in Patients With Long-term Mitral Regurgitation Circulation, August 15, 1995; 92(4): 811 - 818. [Abstract] [Full Text]
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 BETTER OUTCOMES AFTER SURGERY FOR MITRAL REGURGITATION Journal Watch (General), August 30, 1994; 1994(830): 3 - 3. [Full Text]
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