PMID- 10758378
OWN - NLM
STAT- MEDLINE
DCOM- 20000606
LR  - 20190513
IS  - 1010-7940 (Print)
IS  - 1010-7940 (Linking)
VI  - 17
IP  - 3
DP  - 2000 Mar
TI  - Mitral valve surgery in patients with severe left ventricular dysfunction.
PG  - 213-21
AB  - 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.
FAU - Bishay, E S
AU  - Bishay ES
AD  - Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic 
      Foundation, Cleveland, OH 44195, USA.
FAU - McCarthy, P M
AU  - McCarthy PM
FAU - Cosgrove, D M
AU  - Cosgrove DM
FAU - Hoercher, K J
AU  - Hoercher KJ
FAU - Smedira, N G
AU  - Smedira NG
FAU - Mukherjee, D
AU  - Mukherjee D
FAU - White, J
AU  - White J
FAU - Blackstone, E H
AU  - Blackstone EH
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve Insufficiency/*complications/diagnostic 
      imaging/mortality/physiopathology/*surgery
MH  - Stroke Volume
MH  - Survival Analysis
MH  - Ultrasonography
MH  - Ventricular Dysfunction, Left/*complications/diagnostic imaging
EDAT- 2000/04/12 09:00
MHDA- 2000/06/10 09:00
CRDT- 2000/04/12 09:00
PHST- 2000/04/12 09:00 [pubmed]
PHST- 2000/06/10 09:00 [medline]
PHST- 2000/04/12 09:00 [entrez]
AID - S1010-7940(00)00345-6 [pii]
AID - 10.1016/s1010-7940(00)00345-6 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2000 Mar;17(3):213-21. doi: 
      10.1016/s1010-7940(00)00345-6.