Mitral valve repair in patients with low left ventricular ejection fractions: early and late results.

STUDY OBJECTIVES

This retrospective study was performed to examine the outcome of mitral valve repair (ie, mitral valvuloplasty [MVP]) in relation to preoperative low left ventricular ejection fraction (LVEF).

DESIGN AND SETTINGS

From our series of 338 consecutive patients who underwent MVP between 1983 and 2001, we compared the course of 302 patients with preoperative LVEF of > 35% (group I) to that of 36 patients with LVEF of </= 35% (group II).

RESULTS

Preoperatively, group II patients were more likely to be associated with ischemic heart disease (IHD) [p < 0.0002], and to have undergone emergency surgery (p < 0.02) and concomitant coronary artery bypass graft surgery (CABG) [p < 0.02]. The perioperative mortality rate was 8% for group II and 2% for group I (p < 0.03). On multivariate analysis, predictors of increased operative mortality were emergent operation (p < 0.001) and preoperative New York Heart Association (NYHA) class IV (p < 0.02). Predictors of overall mortality (early and late) included emergency operation (p < 0.02), preoperative NYHA class IV (p < 0.002), and IHD (p < 0.0001). Postoperatively, 78% of patients from both groups were in NYHA class I/II. The 5-year rate of freedom from reoperation was 89%. The estimated overall 5-year survival rate (early and late) was 82% for group I and 54% for group II (p < 0.02), and when associated with prior CABG, prior myocardial infarction, or concomitant CABG, it was 0%, 37%, and 63%, respectively, in group II.

CONCLUSIONS

Good symptomatic relief and acceptable overall survival can be obtained in patients in both groups after they have undergone MVP, in the absence of serious comorbidities. Preoperative NYHA class IV and end-stage IHD increase early and late mortality, particularly in group II patients, in whom surgery may be a salvage effort only. Prognosis is dismal in group II patients who have previously undergone CABG. In chronic cases, an early referral for MVP electively before deterioration to end-stage heart disease would improve survival even in patients with low LVEF.