Key result
In patients undergoing minimally invasive mitral valve surgery, preoperative mild or greater tricuspid regurgitation was a significant predictor of negative LVEF evolution at 1 year (OR 1.64; P<0.05).
Why the study?
Although minimally invasive mitral valve surgery has become the first choice for primary mitral regurgitation, clinical evidence remains limited.
What factors impact the evolution of left ventricular ejection fraction after minimally invasive mitral valve surgery in patients with primary mitral regurgitation?
Cohort (n=436)
What factors impact the evolution of left ventricular ejection fraction after minimally invasive mitral valve surgery in patients with primary mitral regurgitation?
Following minimally invasive mitral valve surgery for primary mitral regurgitation, LVEF slightly declines at 1 year, with higher preoperative LVEF and mild or greater tricuspid regurgitation predicting a worse LVEF evolution.
Answers are grounded in this paper and cite their sources.
May inform LVEF risk stratification in mitral surgery; leaves open whether addressing TR alters remodeling.
BACKGROUND: Although minimally invasive mitral valve surgery (MIMVS) has become the first choice for primary mitral regurgitation (MR) in recent years, clinical evidence in this field is yet limited. The main focus of this study was the analysis of preoperative (Pre), postoperative (Post), and 1-year follow-up (Fu) data in our series of MIMVS to identify factors that have an impact on the left ventricular ejection fraction (LVEF) evolution after MIMVS. METHODS: We reviewed the perioperative and 1-year follow-up data from 436 patients with primary MR (338 isolated MIMVS und 98 MIMVS combined with tricuspid valve repair) to analyze patients' baseline characteristics, the change of LV size, the postoperative evolution of LVEF and its factors, and the clinical outcomes. RESULTS: The overall mean value of ejection fraction (EF) slightly decreased at 1-year follow-up (mean change of LVEF: -2.63 ± 9.00%). A significant correlation was observed for preoperative EF (PreEF) und EF evolution, the higher PreEF the more pronounced decreased EF evolution (in all 436 patients; r = -.54, p < .001, in isolated MIMVS; r = -.54, p < .001, in combined MIMVS; r = -.53, p < .001). Statistically significant differences for negative EF evolution were evident in patients with mild or greater tricuspid valve regurgitation (TR) (in all patients; p < .05, odds ratio [OR] = 1.64, in isolated MIMVS; p < .01, OR = 1.93, respectively). Overall clinical outcome in New York Heart Association classification at 1 year was remarkably improved. CONCLUSIONS: Our results suggest an excellent clinical outcome at 1 year, although mean LVEF slightly declined over time. TR could be a predictor of worsened follow-up LVEF in patients undergoing MIMVS.
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Sugimura et al. (2020) conducted a cohort in Primary mitral regurgitation (n=436). Mild or greater tricuspid valve regurgitation vs. Less than mild tricuspid valve regurgitation was evaluated on Negative left ventricular ejection fraction (LVEF) evolution (OR 1.64, p=<0.05). In patients undergoing minimally invasive mitral valve surgery, preoperative mild or greater tricuspid regurgitation was a significant predictor of negative LVEF evolution at 1 year (OR 1.64; P<0.05).
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