Abstract 9728: The Timing of Valve Repair for Severe Degenerative Mitral Regurgitation and the Long-term Left Ventricular Function
Background: The current ACC/AHA guideline recommends early mitral valve (MV) repair for asymptomatic severe mitral regurgitation (MR) in the absence of left ventricular (LV) dysfunction. However, the effects of early MV repair on the long-term LV function and the threshold of the preoperative parameters to maintain favorable long-term LV function have not been clarified. This study aimed to evaluate the incidence and predictors of postoperative LV dysfunction as well as the clinical outcomes.
Methods: A total of 908 patients who underwent MV repair for severe degenerative MR in our institution between 1996 and 2010 were retrospectively reviewed. Among them, both preoperative and 3-year postoperative echocardiographic data were available in 437 patients. Pre- and postoperative echocardiographic data and clinical outcomes were evaluated.
Results: Receiver-operating characteristics curve analysis identified preoperative LV ejection fraction (EF) >65% (area under curve (AUC), 0.65; P<0.001) and LV end-systolic dimension (ESD) <38 mm (AUC, 0.68; P<0.001) as cut off values for predicting LVEF ≥60% 3 years after surgery. Patients were divided into 2 groups according to the preoperative LV measures; group A (n=193), LVEF >65% and LVESD <38mm and group B (n=280), LVEF ≤65% and/or LVESD ≥38mm. There were significantly higher rates of postoperative LV dysfunction in group B (A vs B, 24% vs 49%, P<0.001). Moreover, the 10-year event-free survival rate, defined as a composite of death, hospitalization because of heart failure, and recurrent MR was significantly lower in group B than those in group A (A vs B, 86% vs 70%, P=0.02). Among patients in group A, preoperative LVESD was the only independent predictor of postoperative LV dysfunction.
Conclusion: Simple preoperative echocardiography measures allow the prediction of postoperative LV dysfunction. Patients with preoperative LVEF >65% and LVESD <38 mm may offer better long-term postoperative LV function.
- © 2012 by American Heart Association, Inc.