Copyright © 2005, The European Society of Cardiology
Mitral valve repair versus replacement for isolated non-ischemic mitral regurgitation in patients with preoperative left ventricular dysfunction. A long-term follow-up echocardiography study
aWestern Attica General Hospital, Athens, Greece
bHammersmith Hospital, Imperial College, London, UK
Received 12 October 2004; received in revised form 15 January 2005; accepted after revision 21 January 2005.
nikoskou{at}otenet.gr
* Corresponding author. 4, Agiou Georgiou Street, 15236, N. Penteli, Athens, Greece. Tel.: +30 210 8041601; fax: +30 210 5698465.
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Abstract |
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The aim of this study was to evaluate LV function, by means of echocardiography, after mitral valve repair (MVr) or mitral valve replacement (MVR) in patients (pts) with chronic degenerative mitral regurgitation (MR) and depressed LV systolic function during a 6-years follow-up (FU) period.
Patients and methods
Forty-five pts with moderately severe or severe MR and preoperative EF
50% were divided into 2 groups: MVr group (27 pts, 19 men–8 women, aged 62±10 years) and MVR group (18 pts, 8 men–10 women, aged 60±12 years). The cause of MR was myxomatous mitral valve disease (MVr/MVR: 16/8), endocarditis (0/4) and degenerative mitral valves with ruptured chordae tendineae (11/6). All pts underwent transthoracic echocardiography preoperatively, postoperatively and annually during the FU period (6±3 years).
Results
In MVr group, 5 pts died, 5 were lost to FU and 2 pts underwent MVR due to MVr failure. In MVR group, 6 pts died, 3 were lost to FU and 1 was re-operated due to prosthetic valve endocarditis. Atrial fibrillation was similar between the 2 groups. MVr pts demonstrated significant LVEDD decrease postoperatively which was persistent during FU (p<0.05). LVESD also decreased (p<0.05), VTI improved (p<0.05), while FS and EF showed a trend to improve. In MVR pts, LVEDD was decreased (p<0.05) but increased during FU (p<0.05) and LVESD remained high, resulting in a decrease of FS and EF (p<0.05). VTI remained unchanged (p=NS).
Conclusion
MVr in pts with non-ischemic MR and preoperative LV dysfunction achieves better preservation of LV systolic indices than MVR, probably due to preservation of the subvalvular apparatus and LV geometry.
Keywords: Mitral regurgitation; Depressed LV function; Mitral valve repair
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