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• W2320859865 abstract "BackgroundThe impact of preoperative left ventricle (LV) size on long-term outcomes following repair of non-ischemic mitral regurgitation (MR) remains unclear. Evidence suggests that LV dilatation is a risk factor for unsuccessful repair and subsequent valve replacement, but little other data is available. This study was conducted to evaluate the impact of preoperative LV size on postoperative LV function, recurrent MR (≥2+) and long-term survival in patients following mitral valve repair of non-ischemic MR.MethodsBetween 2002 and 2010, 463 patients, mean age 62.4 ± 13.3 years, underwent mitral valve repair of non-ischemic MR and had detailed preoperative and postoperative LV size measurements. Preoperative and postoperative LV function were divided into 4 classes of increasing dysfunction: I, LV ejection fraction (EF) >50%; II, LVEF ≥35% and ≤50%; III, LVEF ≥20% and <35%; IV, LVEF <20%. The etiology of MR was due to cardiomyopathy in 24 (5%), degenerative disease in 181 (39%), endocarditis in 25 (5%), myxomatous disease in 244 (53%), rheumatic disease in 30 (6%), and other causes in 9 (2%). Clinical and echocardiographic follow-up extended up to 8.6 years.ResultsPreoperative indexed LV end-systolic diameter (LVESD) was 19.3 ± 4.9 mm/m2. Preoperative LV ejection fraction was less than 35% in 29 patients (6%). Thirty-day mortality was 0%. Postoperative LV function worsened by at least one class in 109 (24%) patients. Notably, an indexed LVESD of ≥18 mm/m2 was associated with deterioration in postoperative LV class (Figure). Larger indexed LVESD was also associated with worse postoperative LV function in the subset of patients with preoperative New York Heart Association Functional Class symptoms ≤2 (hazard ratio (HR) 1.08 ± 0.03 per mm/m2), and in patients with preoperative LVEF >50% (HR 1.08 ± 0.04 per mm/m2) (both P < 0.03). Freedom from recurrent MR (≥2+) and survival were 90.4 ± 2.5% and 89.8 ± 2.3% at 5-years, respectively. Both recurrent MR (≥2+) and survival were not associated with preoperative indexed LVESD (both P > 0.2).ConclusionLarger preoperative LV size is associated with worse LV function following mitral valve repair of non-ischemic MR. However, mitral valve repair can be performed with favorable outcomes in this population. These data suggest that repair of non-ischemic MR should not be delayed since postoperative LV dysfunction may occur even with normal preoperative LV size. BackgroundThe impact of preoperative left ventricle (LV) size on long-term outcomes following repair of non-ischemic mitral regurgitation (MR) remains unclear. Evidence suggests that LV dilatation is a risk factor for unsuccessful repair and subsequent valve replacement, but little other data is available. This study was conducted to evaluate the impact of preoperative LV size on postoperative LV function, recurrent MR (≥2+) and long-term survival in patients following mitral valve repair of non-ischemic MR. The impact of preoperative left ventricle (LV) size on long-term outcomes following repair of non-ischemic mitral regurgitation (MR) remains unclear. Evidence suggests that LV dilatation is a risk factor for unsuccessful repair and subsequent valve replacement, but little other data is available. This study was conducted to evaluate the impact of preoperative LV size on postoperative LV function, recurrent MR (≥2+) and long-term survival in patients following mitral valve repair of non-ischemic MR. MethodsBetween 2002 and 2010, 463 patients, mean age 62.4 ± 13.3 years, underwent mitral valve repair of non-ischemic MR and had detailed preoperative and postoperative LV size measurements. Preoperative and postoperative LV function were divided into 4 classes of increasing dysfunction: I, LV ejection fraction (EF) >50%; II, LVEF ≥35% and ≤50%; III, LVEF ≥20% and <35%; IV, LVEF <20%. The etiology of MR was due to cardiomyopathy in 24 (5%), degenerative disease in 181 (39%), endocarditis in 25 (5%), myxomatous disease in 244 (53%), rheumatic disease in 30 (6%), and other causes in 9 (2%). Clinical and echocardiographic follow-up extended up to 8.6 years. Between 2002 and 2010, 463 patients, mean age 62.4 ± 13.3 years, underwent mitral valve repair of non-ischemic MR and had detailed preoperative and postoperative LV size measurements. Preoperative and postoperative LV function were divided into 4 classes of increasing dysfunction: I, LV ejection fraction (EF) >50%; II, LVEF ≥35% and ≤50%; III, LVEF ≥20% and <35%; IV, LVEF <20%. The etiology of MR was due to cardiomyopathy in 24 (5%), degenerative disease in 181 (39%), endocarditis in 25 (5%), myxomatous disease in 244 (53%), rheumatic disease in 30 (6%), and other causes in 9 (2%). Clinical and echocardiographic follow-up extended up to 8.6 years. ResultsPreoperative indexed LV end-systolic diameter (LVESD) was 19.3 ± 4.9 mm/m2. Preoperative LV ejection fraction was less than 35% in 29 patients (6%). Thirty-day mortality was 0%. Postoperative LV function worsened by at least one class in 109 (24%) patients. Notably, an indexed LVESD of ≥18 mm/m2 was associated with deterioration in postoperative LV class (Figure). Larger indexed LVESD was also associated with worse postoperative LV function in the subset of patients with preoperative New York Heart Association Functional Class symptoms ≤2 (hazard ratio (HR) 1.08 ± 0.03 per mm/m2), and in patients with preoperative LVEF >50% (HR 1.08 ± 0.04 per mm/m2) (both P < 0.03). Freedom from recurrent MR (≥2+) and survival were 90.4 ± 2.5% and 89.8 ± 2.3% at 5-years, respectively. Both recurrent MR (≥2+) and survival were not associated with preoperative indexed LVESD (both P > 0.2). Preoperative indexed LV end-systolic diameter (LVESD) was 19.3 ± 4.9 mm/m2. Preoperative LV ejection fraction was less than 35% in 29 patients (6%). Thirty-day mortality was 0%. Postoperative LV function worsened by at least one class in 109 (24%) patients. Notably, an indexed LVESD of ≥18 mm/m2 was associated with deterioration in postoperative LV class (Figure). Larger indexed LVESD was also associated with worse postoperative LV function in the subset of patients with preoperative New York Heart Association Functional Class symptoms ≤2 (hazard ratio (HR) 1.08 ± 0.03 per mm/m2), and in patients with preoperative LVEF >50% (HR 1.08 ± 0.04 per mm/m2) (both P < 0.03). Freedom from recurrent MR (≥2+) and survival were 90.4 ± 2.5% and 89.8 ± 2.3% at 5-years, respectively. Both recurrent MR (≥2+) and survival were not associated with preoperative indexed LVESD (both P > 0.2). ConclusionLarger preoperative LV size is associated with worse LV function following mitral valve repair of non-ischemic MR. However, mitral valve repair can be performed with favorable outcomes in this population. These data suggest that repair of non-ischemic MR should not be delayed since postoperative LV dysfunction may occur even with normal preoperative LV size. Larger preoperative LV size is associated with worse LV function following mitral valve repair of non-ischemic MR. However, mitral valve repair can be performed with favorable outcomes in this population. These data suggest that repair of non-ischemic MR should not be delayed since postoperative LV dysfunction may occur even with normal preoperative LV size." @default.
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• W2320859865 title "475 Larger left ventricle size negatively impacts late postoperative left ventricle function following mitral valve repair" @default.
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