Abstract 11402: Larger Left Ventricle Size Predicts Worse Postoperative Left Ventricle Function Following Repair of Non-Ischemic Mitral Regurgitation
Introduction: The impact of preoperative left ventricle (LV) size on late outcomes following repair of non-ischemic mitral regurgitation (MR) remains unclear.
Hypothesis: We assessed the hypothesis that preoperative LV size impacts postoperative LV function, recurrent MR (≥2+), and long-term survival in this population.
Methods: Four hundred sixty-three patients, mean age 62.4±13.3 years, underwent mitral valve repair of non-ischemic MR between 2002 and 2010, and had detailed preoperative and postoperative LV size measurements. Preoperative and postoperative LV function were divided into 4 classes based on LV ejection fraction: I, >50%; II, 35-50%; III, 20-34%; IV, <20%. Clinical and echocardiographic follow-up extended up to 8.6 years.
Results: Preoperative indexed LV end-systolic diameter (LVESD) was 19.3±4.9 mm/m2. Preoperative LV ejection fraction was less than 35% in 29 patients (6%). Postoperative LV function worsened by at least one class in 109 (24%) patients. Thirty-day mortality was 0%. After adjusting for age and preoperative LV class, indexed LVESD ≥18 mm/m2 was associated with worse postoperative LV function (hazard ratio (HR) 2.2, 95% CI 1.1-4.3, P=0.03). Notably, indexed LVESD was associated with worse postoperative LV function in the subset of patients with preoperative New York Heart Association class symptoms ≤2+ (HR 2.7, 95% CI 1.3-5.5, P=0.008), and in those with a class I LV preoperatively (HR 2.5, 95% CI 1.2-5.0, P=0.01). Freedom from recurrent MR (≥2+) and survival were 90.4±2.5% and 89.8±2.3% at 5-years, respectively, and were not associated with preoperative indexed LVESD (both P>0.2).
Conclusions: Larger preoperative LV size is associated with worse LV function following mitral valve repair of non-ischemic MR. However, mitral valve repair can be performed with favorable outcomes in this population. These data suggest that repair of non-ischemic MR should not be delayed since postoperative LV dysfunction may occur even with normal preoperative LV size.
- © 2011 by American Heart Association, Inc.