Mitral valve repair for 52 patients with severe left ventricular dysfunction.

BACKGROUND: Mitral valve (MV) repair is considered to provide more favorable results than MV replacement. MV repair in a patient with severe left ventricular (LV) dysfunction could be associated with higher early and late mortality. Surgical indication of MV repair for those with low LV ejection fraction (LVEF) is still controversial.

PATIENTS AND METHODS: Fifty-two patients with severe mitral regurgitation (MR) and severe LV dysfunction (EF < 35%) underwent MV repair with or without concomitant procedure. The commonest etiology of MV disease was ischemic origin (78.8%), which underwent annuloplasty alone. Their pre- and perioperative parameters were analyzed to identify the risk factor for mortality. The follow-up data of hospital survivors were collected.

RESULTS: Early mortality was 9.6%. The cause of all deaths was low cardiac output syndrome. Actuarial survival was 81.6% at 2 years and 76.5% at 5 years. Multivariate analyses revealed chronic hemodialysis and EF < 25% to be the risk factors for early and late mortality. Among hospital survivors, significant improvement of LVEF (29.9 to 37.4%) and reduction of LV diastolic dimension (62.8 to 57.9 mm) were observed during follow-up.

CONCLUSION: MV repair is effective to improve long-term prognosis of high-risk patients of severe MR with severe LV dysfunction.