PMID- 15364746
OWN - NLM
STAT- MEDLINE
DCOM- 20041102
LR  - 20061115
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 126
IP  - 3
DP  - 2004 Sep
TI  - Mitral valve repair in patients with low left ventricular ejection fractions: 
      early and late results.
PG  - 709-15
AB  - STUDY OBJECTIVES: This retrospective study was performed to examine the outcome 
      of mitral valve repair (ie, mitral valvuloplasty [MVP]) in relation to 
      preoperative low left ventricular ejection fraction (LVEF). DESIGN AND SETTINGS: 
      From our series of 338 consecutive patients who underwent MVP between 1983 and 
      2001, we compared the course of 302 patients with preoperative LVEF of > 35% 
      (group I) to that of 36 patients with LVEF of </= 35% (group II). RESULTS: 
      Preoperatively, group II patients were more likely to be associated with ischemic 
      heart disease (IHD) [p < 0.0002], and to have undergone emergency surgery (p < 
      0.02) and concomitant coronary artery bypass graft surgery (CABG) [p < 0.02]. The 
      perioperative mortality rate was 8% for group II and 2% for group I (p < 0.03). 
      On multivariate analysis, predictors of increased operative mortality were 
      emergent operation (p < 0.001) and preoperative New York Heart Association (NYHA) 
      class IV (p < 0.02). Predictors of overall mortality (early and late) included 
      emergency operation (p < 0.02), preoperative NYHA class IV (p < 0.002), and IHD 
      (p < 0.0001). Postoperatively, 78% of patients from both groups were in NYHA 
      class I/II. The 5-year rate of freedom from reoperation was 89%. The estimated 
      overall 5-year survival rate (early and late) was 82% for group I and 54% for 
      group II (p < 0.02), and when associated with prior CABG, prior myocardial 
      infarction, or concomitant CABG, it was 0%, 37%, and 63%, respectively, in group 
      II. CONCLUSIONS: Good symptomatic relief and acceptable overall survival can be 
      obtained in patients in both groups after they have undergone MVP, in the absence 
      of serious comorbidities. Preoperative NYHA class IV and end-stage IHD increase 
      early and late mortality, particularly in group II patients, in whom surgery may 
      be a salvage effort only. Prognosis is dismal in group II patients who have 
      previously undergone CABG. In chronic cases, an early referral for MVP electively 
      before deterioration to end-stage heart disease would improve survival even in 
      patients with low LVEF.
FAU - Talwalkar, Nirupama G
AU  - Talwalkar NG
AD  - The Methodist Hospital, Houston, TX 77030, USA.
FAU - Earle, Nan R
AU  - Earle NR
FAU - Earle, Elizabeth Ann
AU  - Earle EA
FAU - Lawrie, Gerald M
AU  - Lawrie GM
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiac Output, Low/classification/mortality/*surgery
MH  - Combined Modality Therapy
MH  - Comorbidity
MH  - *Coronary Artery Bypass
MH  - Coronary Disease/classification/mortality/surgery
MH  - *Emergencies
MH  - Female
MH  - Follow-Up Studies
MH  - *Heart Valve Prosthesis Implantation
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/*surgery
MH  - Mitral Valve Insufficiency/mortality/*surgery
MH  - Postoperative Complications/*mortality
MH  - Retrospective Studies
MH  - Survival Rate
MH  - Ventricular Dysfunction, Left/classification/mortality/*surgery
EDAT- 2004/09/15 05:00
MHDA- 2004/11/04 09:00
CRDT- 2004/09/15 05:00
PHST- 2004/09/15 05:00 [pubmed]
PHST- 2004/11/04 09:00 [medline]
PHST- 2004/09/15 05:00 [entrez]
AID - S0012-3692(15)31209-5 [pii]
AID - 10.1378/chest.126.3.709 [doi]
PST - ppublish
SO  - Chest. 2004 Sep;126(3):709-15. doi: 10.1378/chest.126.3.709.