Hospital and mid-term results of surgery for mitral valve regurgitation in patients with severe left ventricular systolic dysfunction
Abstract
Introduction: Preoperative left ventricular ejection fraction (LVEF) is the most important prognostic factor for surgery for mitral regurgitation (MR). The indications for surgery in patients with MR and severe LV dysfunction remain controversial.
The aim of our study was to evaluate the short- and mid-term results of surgery for MR with severe LV dysfunction (defined as LVEF <= 30%). Material and methods: From January 2002 through March 2006, we performed mitral valve surgery in 601 consecutive patients.
Based on retrospective analysis, we identified 40 patients (30 men, 10 women) aged 65.7 +- 9.4 years, who fulfilled the criteria of significant MR and LVEF <= 30% (27.9 +- 12.3%). We investigated the etiology and preoperative clinical and echocardiographic parameters - these were also evaluated after surgery during hospitalization, 30 days and 1 year after the operation.
We determined the 1- and 2-year survival rates as well. Results: The preoperative logistic EuroSCORE was 20.6 +- 11.6.
Ischemic etiology was the cause of MR in 32 patients (80%). Mitral valve repair was performed in 37 (92.5%) patients and replacement in 3.
In-hospital mortality was 10% (4 patients). The 30-day, and one-, and two-year survival rates were 90%, 87.5% and 85%, respectively.
ECHO parameters: before surgery, one month and one year after surgery - EF (%) - 27.9 +- 2.3; 30.6 +- 6.8; 37.6 +- 12.5, LV end-systolic diameter (mm) - 55.9 +- 10.3; 53.5 +- 8.9; 50.6 +- 10.9; LV end-diastolic diameter (mm) - 68.0 +- 8.8; 65.6 +- 8.5; 62.9 +- 9.7; MR grade - 2.9 +- 0.5; 0.2 +- 0.4; 0.4 +- 0.9, respectively. All the differences in all of the above parameters reached statistical significance.
Two patients had MR grade 3 at one-year follow-up, one of them was in NYHA class III and was successfully reoperated (valve replacement by bioprosthesis). The other one was in NYHA class II and refused reoperation.
For the whole group, the mean NYHA fell from preoperative 2.8 +- 0.8 to 1.6 +- 0.6 (p < 0.01). Conclusions: Even in this high-risk group of patients, the operative and mainly mid-term results are surprisingly good.
The overall mortality is acceptable and the quality of life has improved considerably. We observe early reverse remodelling and significant improvement of LV function.