Echo cardiographic prediction of left ventricular dysfunction after mitral valve repair for mitral regurgitation as an indicator to decide the optimal timing of repair

Sakakibara Heart Institute, Фучу, Tōkyō, Japan
Journal of the American College of Cardiology (Impact Factor: 16.5). 08/2003; 42(3):458-63. DOI: 10.1016/S0735-1097(03)00649-1
Source: PubMed


This study sought to determine whether echocardiography before mitral valve repair (MVR) for mitral regurgitation (MR) was predictive of postoperative left ventricular (LV) dysfunction and useful for deciding the optimal timing of repair.
Some reports have shown that the preoperative echocardiographic data of left ventricular ejection fraction (LVEF) and left ventricular end-systolic diameter (LVDs) were good predictors of postoperative LV dysfunction. However, few reports were based on long-term follow-up data of large numbers of patients who underwent MVR in the last decade.
A total of 274 patients with moderate or severe MR underwent MVR between October 1, 1991, and September 30, 2000. Among them, 171 patients who had both an operation for isolated MR due to degenerative pathology and a postoperative echocardiogram were studied. Postoperative echocardiograms were performed 3.9 +/- 2.4 years after the operation. The LVEF decreased from 66 +/- 10% before surgery to 63 +/- 11% after surgery (p < 0.0001). On univariate analysis, preoperative LVEF and LVDs correlated with postoperative LVEF (r = 0.41 and r = -0.39, respectively). Overall, postoperative LV dysfunction (defined as LVEF <50%) was not frequent (12%). However, the incidence of postoperative LV dysfunction was high in patients with preoperative LVEF <55% (38%) or LVDs > or =40 mm (23%).
In patients with MR, the echocardiographic data of LVEF and LVDs were good predictors of postoperative LV dysfunction. When a decrease in LVEF or an increase in LVDs is detected, MVR should be considered to preserve postoperative LV function.

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Available from: Kaoru Tanaka,
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    • "These criteria, elaborated upon earlier, were largely derived from studies on preoperative determinants of outcome after surgery which do not necessarily represent optimal thresholds for intervention. For instance, in the study of Matsumura et al.,25) 6-7% of patients developed postoperative LV dysfunction despite having an LVESD < 40 mm at outset. Long-term outcomes data from a large Mayo Clinic cohort of 1063 patients who had MV repair or replacement indicate a greater likelihood of optimal LVEF recovery i.e. > 60% if preoperative LVEF was > 65% (hazard ratio, 1.7) or LVESD < 36 mm (hazard ratio, 2.0).26) "
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    ABSTRACT: Severe primary mitral regurgitation (MR) is a progressive condition which engenders significant mortality and morbidity if left untreated. The optimal timing of surgery in patients with MR of degenerative origin continues to be debated, especially for those who are asymptomatic. Apart from symptoms, current authoritative guidelines recommend intervention when there is incipient left ventricular dysfunction, pulmonary hypertension or new onset atrial fibrillation. This review focuses on the asymptomatic subject with severe MR, and examines contemporary clinical decision-making and management strategies, including the 2012 European guidelines on valvular heart disease. We discuss the rationale for risk stratifying the asymptomatic individual, and highlight current and novel diagnostic tools that may have a useful role, with an emphasis on echocardiographic imaging.
    Journal of cardiovascular ultrasound 12/2012; 20(4):165-71. DOI:10.4250/jcu.2012.20.4.165
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    • "Another limitation is that we cannot definitively conclude whether the differences among surgery types were caused by primary disease or the surgery itself [5] [23], even though the preoperative ejection fraction was relatively low in the majority of VS patients, and whether CAS patients with severe systolic dysfunction would have similarly responded as the VS patients. However, preoperative left ventricular dysfunction in patients undergoing valve repair is a major risk factor for direct postoperative dysfunction [21] "
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    ABSTRACT: Mitral valve repair is the only heart valve operation with the potential to restore a patient to expected survival. A mandate currently exists for early surgical repair of mitral regurgitation before the onset of symptoms and significant left ventricular dysfunction. It is based upon a better understanding of the natural history of mitral regurgitation, the poor results with medical therapy, and the negative impact of abnormal left ventricular size and function, and symptoms of long-term survival. It is also based on better operative mortality, quality of life, and longevity with repair compared with replacement. Despite the existence of this mandate, overall mitral valve repair rates remain generally low in the United States. The biggest impact on mitral repair rates is likely to come from cardiologists, who would embrace the mandate and insist on mitral valve repair and refer their patients to surgeons who consistently and successfully repair mitral valves.
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