Key result
Mitral valve surgery in patients with severe mitral regurgitation and end-systolic diameter ≥ 51 mm was associated with improved ejection fraction when symptoms lasted ≤ 48 months (p=0.01).
Why the study?
Does mitral valve surgery improve left ventricular function in patients with severe chronic mitral regurgitation and end-systolic diameter >= 51 mm?
Cohort (n=11)
Does mitral valve surgery improve left ventricular function in patients with severe chronic mitral regurgitation and end-systolic diameter >= 51 mm?
In a small cohort of patients with severe chronic mitral regurgitation and end-systolic diameter >= 51 mm, mitral valve surgery improved left ventricular function, particularly in those with symptom duration <= 48 months.
Suggests symptom duration may guide surgical timing in severe MR; hypothesis-generating and requires prospective validation.
OBJECTIVE: To evaluate whether left ventricular end-systolic (ESD) diameters < or = 51mm in patients (pt) with severe chronic mitral regurgitation (MR) are predictors of a poor prognosis after mitral valve surgery (MVS). METHODS: Eleven pt (aged 36 +/- 13 years) were studied in the preoperative period (pre), median of 36 days; in the early postoperative period (post1), median of 9 days; and in the late postoperative period (post2), mean of 38.5 +/- 37.6 months. Clinical and echocardiographic data were gathered from each pt with MR and systolic diameter > or = 51 mm (mean = 57 +/- 4mm) to evaluate the result of MVS. Ten patients were in NYHA Class III/IV. RESULTS: All but 2 pt improved in functional class. Two pt died from heart failure and infectious endocarditis 14 and 11 months, respectively, after valve replacement. According to ejection fraction (EF) in post2, we identified 2 groups: group 1 (n=6), whose EF decreased in post1, but increased in post2 (p=0.01) and group 2 (n=5), whose EF decreased progressively from post1 to post2 (p=0.10). All pt with symptoms lasting < or = 48 months had improvement in EF in post2 (p=0.01). CONCLUSION: ESD > or = 51 mm are not always associated with a poor prognosis after MVS in patients with MR. Symptoms lasting up to 48 months are associated with improvement in left ventricular function.
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Rocha et al. (2003) conducted a cohort in severe chronic mitral regurgitation (n=11). Mitral valve surgery was evaluated on Ejection fraction improvement. Mitral valve surgery in patients with severe mitral regurgitation and end-systolic diameter ≥ 51 mm was associated with improved ejection fraction when symptoms lasted ≤ 48 months (p=0.01).
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