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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    • "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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