Outcome after surgery for mitral regurgitation. Determinants of postoperative morbidity and mortality

Background and aims of the study: The incidence and impact of congestive heart failure and coronary artery disease on late survival after surgical correction of mitral regurgitation are poorly defined. In addition to the uncertainty about the frequency of this complication, the mechanisms of heart failure have not been fully analyzed. Methods: To determine survival and the incidence and mechanisms of congestive heart failure after mitral valve surgery for mitral regurgitation, we analyzed the long-term outcome of 576 consecutive postoperative survivors. Results: The analysis demonstrated that preserved preoperative left ventricular function (ejection fraction ≤ 60%) was associated with improved survival (adjusted risk ratio 0.49; 95% C.I. 0.36-0.661) and reduced incidence of congestive heart failure (adjusted risk ratio 0.30; 95% C.I. 0.20-0.441), while concomitant coronary artery disease was associated with an excess mortality (adjusted risk ratio 1.80; 95% C.I. 1.34-2.41) and incidence of congestive heart failure (adjusted risk ratio 2.12; 95% C.I. 1.48-3.031). Conclusion: These results suggest that left ventricular dysfunction and coronary artery disease are major determinants of mortality and morbidity after surgical correction of mitral regurgitation. For the prevention of postoperative congestive heart failure, early surgical correction of mitral regurgitation should be considered before left ventricular dysfunction occurs.