Recovery of left ventricular function after surgical correction of mitral regurgitation caused by leaflet prolapse

Rakesh M. Suri, Hartzell V Schaff, Joseph A. Dearani, Thoralf M. Sundt, Richard C. Daly, Charles J. Mullany, Maurice E Sarano, Thomas A. Orszulak

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Objective: Recovery of ventricular function after surgical correction of mitral regurgitation is often incomplete. We studied clinical and echocardiographic factors influencing return of normal left ventricular ejection fraction after mitral valve repair or replacement for mitral regurgitation caused by leaflet prolapse. Methods: We evaluated 1063 patients who had mitral valve repair or replacement between January 1, 1980, and December 31, 2000. A total of 2488 echocardiograms with follow-up ejection fractions were available for analysis. Results: Of the patients, 761 were men, 924 had valve repair, and 85% underwent surgery during the study's second decade. Compared with patients who had the operation in the 1980s, patients who had surgery in the 1990s had significantly smaller preoperative left heart dimensions and a 2.4-fold greater likelihood of an ejection fraction more than 60% during follow-up. Factors independently associated with higher ejection fraction at follow-up included valve repair (vs replacement), freedom from preoperative myocardial infarction, operation in the 1990s, greater preoperative ejection fraction, and smaller left ventricular dimensions. Patients with an ejection fraction of less than 50% at discharge were 3.5-fold less likely to recover normal ejection fraction during long-term follow-up (P < .001). Patients had a greater likelihood of a follow-up ejection fraction more than 60% if preoperative ejection fraction was more than 65% (hazard ratio, 1.7) or left ventricular end-systolic dimension was less than 36 mm (hazard ratio, 2.0). Conclusion: Early repair of mitral regurgitation caused by leaflet prolapse, before deterioration in left heart size or function, increases the likelihood of subsequent normalization of left ventricular ejection fraction.

Original languageEnglish (US)
Pages (from-to)1071-1076
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume137
Issue number5
DOIs
StatePublished - May 2009

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Prolapse
Mitral Valve Insufficiency
Left Ventricular Function
Mitral Valve
Stroke Volume
Likelihood Functions
Ventricular Function
Recovery of Function
Myocardial Infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Recovery of left ventricular function after surgical correction of mitral regurgitation caused by leaflet prolapse. / Suri, Rakesh M.; Schaff, Hartzell V; Dearani, Joseph A.; Sundt, Thoralf M.; Daly, Richard C.; Mullany, Charles J.; Sarano, Maurice E; Orszulak, Thomas A.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 137, No. 5, 05.2009, p. 1071-1076.

Research output: Contribution to journalArticle

Suri, Rakesh M. ; Schaff, Hartzell V ; Dearani, Joseph A. ; Sundt, Thoralf M. ; Daly, Richard C. ; Mullany, Charles J. ; Sarano, Maurice E ; Orszulak, Thomas A. / Recovery of left ventricular function after surgical correction of mitral regurgitation caused by leaflet prolapse. In: Journal of Thoracic and Cardiovascular Surgery. 2009 ; Vol. 137, No. 5. pp. 1071-1076.
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abstract = "Objective: Recovery of ventricular function after surgical correction of mitral regurgitation is often incomplete. We studied clinical and echocardiographic factors influencing return of normal left ventricular ejection fraction after mitral valve repair or replacement for mitral regurgitation caused by leaflet prolapse. Methods: We evaluated 1063 patients who had mitral valve repair or replacement between January 1, 1980, and December 31, 2000. A total of 2488 echocardiograms with follow-up ejection fractions were available for analysis. Results: Of the patients, 761 were men, 924 had valve repair, and 85{\%} underwent surgery during the study's second decade. Compared with patients who had the operation in the 1980s, patients who had surgery in the 1990s had significantly smaller preoperative left heart dimensions and a 2.4-fold greater likelihood of an ejection fraction more than 60{\%} during follow-up. Factors independently associated with higher ejection fraction at follow-up included valve repair (vs replacement), freedom from preoperative myocardial infarction, operation in the 1990s, greater preoperative ejection fraction, and smaller left ventricular dimensions. Patients with an ejection fraction of less than 50{\%} at discharge were 3.5-fold less likely to recover normal ejection fraction during long-term follow-up (P < .001). Patients had a greater likelihood of a follow-up ejection fraction more than 60{\%} if preoperative ejection fraction was more than 65{\%} (hazard ratio, 1.7) or left ventricular end-systolic dimension was less than 36 mm (hazard ratio, 2.0). Conclusion: Early repair of mitral regurgitation caused by leaflet prolapse, before deterioration in left heart size or function, increases the likelihood of subsequent normalization of left ventricular ejection fraction.",
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AU - Schaff, Hartzell V

AU - Dearani, Joseph A.

AU - Sundt, Thoralf M.

AU - Daly, Richard C.

AU - Mullany, Charles J.

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AU - Orszulak, Thomas A.

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