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Late survival after valve operation in patients with left ventricular dysfunction
I G Duarte1, C O Murphy, A S Kosinski
1Carlyle Fraser Heart Center, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30365-2225, USA.
The Annals of Thoracic Surgery
|November 14, 1997
Summary
Left ventricular dysfunction predicts hospital mortality after cardiac valve surgery. While valve operations improve survival, impaired ejection fraction significantly impacts long-term outcomes, suggesting medical management is crucial.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Medicine
Background:
- Left ventricular dysfunction is a known predictor of mortality following cardiac valve operations.
- This study evaluates long-term survival in a large patient cohort with preoperative left ventricular dysfunction.
Purpose of the Study:
- To assess late survival rates in patients with reduced ejection fraction undergoing cardiac valve surgery.
- To identify predictors of hospital mortality and long-term outcomes in this patient group.
Main Methods:
- A cohort of 257 patients with ejection fraction ≤0.40 underwent aortic, mitral, or combined valve operations between 1980 and 1993.
- Follow-up was 98% complete, with survival analyzed using Kaplan-Meier curves and Cox regression.
Main Results:
- Hospital mortality was 12.5%. Independent predictors of hospital mortality included ejection fraction <0.30, mitral regurgitation, and concomitant coronary artery bypass grafting.
- Five-year survival for hospital survivors was 65%. Predictors of poor late outcome included diuretic use, male sex, reoperation, age >60, and aortic regurgitation.
Conclusions:
- Cardiac valve operation does not fully reverse the negative impact of left ventricular dysfunction on long-term survival.
- Postoperative medical management of dilated, remodeled ventricles should be considered if surgery is delayed until dysfunction is significant.