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Isolated mitral valve repair in patients with depressed left ventricular function
Ashish S Shah1, Steven A Hannish, Carmelo A Milano
1Department of General and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA. ashah@duke.edu
The Annals of Thoracic Surgery
|September 27, 2005
Summary
Mitral valve repair (MV repair) in patients with reduced left ventricular function shows low operative mortality. However, risks of death, reoperation, or transplantation persist, with minimally invasive MV repair proving safe.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Heart Valve Repair
Background:
- Mitral valve repair (MV repair) is established for normal left ventricular function.
- Limited data exists on isolated MV repair outcomes in patients with depressed left ventricular function.
Purpose of the Study:
- To review outcomes of isolated MV repair in patients with depressed left ventricular function.
- To examine intermediate outcomes and safety of MV repair in this specific patient group.
Main Methods:
- Retrospective review of 101 patients undergoing isolated MV repair (1996-2003).
- Inclusion criteria: ejection fraction < 0.45.
- Data collected: operative details, survival (Social Security Death Index), reoperation, and transplantation rates.
Main Results:
- Mean follow-up: 1,124 days; mean ejection fraction: 0.34.
- 30-day mortality: 2.9%; 1-year survival: 94%; 5-year survival: 70%.
- No significant survival difference based on ejection fraction or mitral disease type; 5-year freedom from adverse events was 61% (primary) and 54% (secondary). Minimally invasive MV repair (n=57) had 1.7% 30-day mortality.
Conclusions:
- Isolated MV repair is feasible with low operative mortality in patients with depressed left ventricular function.
- Persistent risks of death, reoperation, or transplantation exist regardless of underlying valve disease.
- Minimally invasive MV repair is a safe option for this patient cohort.