Abstract 3333: Vasodilator Therapy and Survival in Patients Undergoing Mitral Valve Surgery for Chronic, Severe, Non-Ischemic Mitral Regurgitation
Introduction: Limited data exist on the survival benefits of vasodilators in patients with mitral regurgitation (MR). We sought to determine if vasodilator therapy prior to mitral valve replacement or repair for MR resulted in either short or long term mortality benefit postoperatively.
Methods: We identified 234 consecutive patients who underwent isolated mitral valve replacement or repair for chronic, severe, non-ischemic MR. We considered regular use of an ACEI, ARB, or hydralazine + isordil for >=1yr to be vasodilator use. A propensity score was calculated to predict vasodilator use by a multiple logistic regression model that included 25 covariates, and was then included in Cox regression analyses after verifying balance of covariates.
Results: The mean age of the cohort was 63 ±11yrs and 50% were female. Mean follow up was 3.8yrs for vasodilator users and 4.3yrs for nonusers, comprising 964 person-years of follow up. There were 24 deaths (16%) among 147 users vs. 7 (8%) among 87 nonusers. Users were older (65 ±10yrs vs. 61 ±12yrs, p=0.004), and more likely to have CHF (p=0.02), hypertension (p<0.0001), diabetes (p=0.007), and higher mean pulmonary arterial systolic pressure or PASBP (51 ± 19mmHg vs. 46 ±19mmHg, p=0.04). Mean EF was 0.60 ± 0.01 and similar between groups (p=0.73). The groups did not differ in: frequency of repair, atrial fibrillation , or intra-aortic balloon pump support (IABP).
Conclusion: Using a propensity score analysis, vasodilator use for >=1yr prior to mitral valve surgery does not confer a survival benefit post-operatively.