Mitral valve surgery in patients with severe left ventricular dysfunction

Ehab S. Bishay, Patrick M. McCarthy*, Delos M. Cosgrove, Katherine J. Hoercher, Nicholas G. Smedira, Debabrata Mukherjee, Jennifer White, Eugene H. Blackstone

*Corresponding author for this work

Research output: Contribution to journalArticle

158 Scopus citations

Abstract

Objectives: The objectives of this study were to determine (1) survival, (2) functional status and freedom from readmission for heart failure and (3) change in postoperative left ventricular (LV) dimensions and function following mitral valve repair or replacement in patients with severe LV dysfunction and mitral regurgitation. Patients and methods: Between 1990 and 1998, 44 patients with mitral regurgitation and a LV ejection fraction <35% (mean±SD, 28±6%) underwent isolated mitral repair (n=35) or replacement (n=9). The etiology of regurgitation was valvular in 18 (40%) patients, ischemic in 13 (30%) patients and dilated idiopathic cardiomyopathy in 13 (30%) patients. Every patient had been hospitalized one to six times for symptoms of heart failure (mean±SD, 2.3±1.5). All patients were receiving maximal drug therapy with 15 (34%) in New York Heart Association (NYHA) class III and 12 (27%) in class IV. Seven (16%) patients were initially referred for consideration of transplantation. The mean±SD duration of follow-up was 40±21 months. Results: One (2.3%) patient died 9 days postoperatively of acute bronchopneumonia. The mean±SD duration of ICU and hospital stay was 41±34 h and 9±3 days, respectively. The 1-, 2- and 5-year survival rates were 89, 86 and 67%, respectively. Heart failure and sudden death accounted for 62% of the late deaths. The NYHA class improved for survivors from 2.8±0.8 preoperatively to 1.2±0.5 at follow-up (P<0.0001). Freedom from readmission for heart failure was 88, 82 and 72% at 1, 2 and 5 years, respectively. No patient has been listed for transplantation. Conclusions: Mitral valve surgery offers symptomatic improvement and survival benefit in patients with severe LV dysfunction and mitral regurgitation. More liberal use of this surgery for cardiomyopathy patients is warranted. Copyright (C) 2000 Elsevier Science B.V.

Original languageEnglish (US)
Pages (from-to)213-221
Number of pages9
JournalEuropean Journal of Cardio-thoracic Surgery
Volume17
Issue number3
DOIs
StatePublished - Mar 1 2000

Keywords

  • Left ventricular dysfunction
  • Mitral valve surgery

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Bishay, E. S., McCarthy, P. M., Cosgrove, D. M., Hoercher, K. J., Smedira, N. G., Mukherjee, D., White, J., & Blackstone, E. H. (2000). Mitral valve surgery in patients with severe left ventricular dysfunction. European Journal of Cardio-thoracic Surgery, 17(3), 213-221. https://doi.org/10.1016/S1010-7940(00)00345-6