Key result
Double valve replacement for combined rheumatic aortic and mitral regurgitation led to an initial decline in ejection fraction that normalized at 1 year (55% vs 60% at baseline; P=0.17).
Why the study?
Does double valve replacement improve left ventricular function over time in patients with combined severe rheumatic aortic and mitral regurgitation?
Cohort (n=44)
Does double valve replacement improve left ventricular function over time in patients with combined severe rheumatic aortic and mitral regurgitation?
Absolute Event Rate: 55% vs 60%
p-value: p=0.17
After double valve replacement for combined rheumatic mitral and aortic regurgitation, left ventricular ejection fraction initially declines but normalizes by 1 year, with baseline end-systolic diameter and ejection fraction predicting postoperative performance.
Supports monitoring for EF recovery after double valve replacement; leaves open randomized confirmation in rheumatic cohorts.
BACKGROUND: The long-term effects of double valve replacement on left ventricular function in patients with combined severe rheumatic aortic and mitral regurgitation have not been reported previously. Furthermore, the importance of chordal preservation in this group of patients is unknown. METHODS AND RESULTS: Serial clinical and echocardiographic evaluations were performed prospectively in 44 patients who underwent double valve replacement for combined aortic and mitral regurgitation. Chordae to the posterior mitral leaflet were preserved in 27 patients. Mean follow-up was 40 +/- 19 months. Left ventricular end-diastolic diameter decreased significantly 3 months after surgery (from 66 +/- 10 to 52 +/- 11 mm; P < .001) without a substantial change in end-systolic diameter, resulting in a significant decline in ejection fraction (from 60 +/- 9% to 48 +/- 15%; P < .001). At 1 year, a significant reduction in end-systolic dimension was observed without a concomitant decline in end-diastolic diameter, thus normalizing the ejection fraction (55 +/- 12%; P = .17 versus baseline). No further changes were seen at latest follow-up. Multivariate regression analysis identified baseline end-systolic diameter and ejection fraction as independent predictors of postoperative systolic performance. Chordal preservation did not emerge as a univariate or multivariate predictor. CONCLUSIONS: After an initial postoperative decline in ejection fraction, normalization in left ventricular systolic function may be expected 1 year after double valve replacement for combined rheumatic mitral and aortic regurgitation. End-systolic diameter and ejection fraction are the only independent predictors of postoperative left ventricular performance.
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Skudicky et al. (1997) conducted a cohort in Combined severe rheumatic aortic and mitral regurgitation (n=44). Double valve replacement vs. Baseline was evaluated on Left ventricular ejection fraction at 1 year (p=0.17). Double valve replacement for combined rheumatic aortic and mitral regurgitation led to an initial decline in ejection fraction that normalized at 1 year (55% vs 60% at baseline; P=0.17).
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