Impact of preoperative left ventricular ejection fraction on postoperative left ventricular remodeling after mitral valve repair for degenerative disease.
OBJECTIVE
Mitral valve repair has been associated with better preservation of left ventricular (LV) function, especially in the setting of degenerative regurgitation. The goal of this study was to evaluate the impact of mitral valve repair on postoperative LV ejection fraction (LVEF) and LV remodeling as determined by LV end-systolic and diastolic diameters.


METHODS
A prospective echocardiographic and clinical evaluation of 91 patients undergoing mitral valve repair for degenerative regurgitation between 1993 and 1998 was performed. Patients with normal preoperative LVEF (> or = 50%; group 1, n = 71) were compared with patients with decreased preoperative LVEF (< 50%; group 2, n = 20) one year after mitral valve repair.


RESULTS
In group 1 patients, the LVEF was preserved at one year, while the LV end-systolic diameter was significantly reduced from 36 +/- 7 mm to 32 +/- 8 mm (p <0.05). There was a significant improvement in LVEF in group 2 patients (38 +/- 6% preoperative versus 50 +/- 12% at one year, p <0.05). The preoperative LV end-systolic diameter was significantly larger in group 2 patients (47 +/- 9 mm) than in group 1 patients (36 +/- 7 mm) (p <0.001), but decreased to normal values at one year after repair (38 +/- 7 mm, p <0.05).


CONCLUSIONS
There was good preservation of LV function after mitral valve repair in group 1 patients. The LVEF significantly increased towards normal in patients with depressed LV function before repair. The LV systolic diameter was restored to normal within one year of repair, even in patients with poor LV function. Decreased preoperative LV function should not be a contraindication to mitral valve repair in patients with degenerative regurgitation.
de Varennes
B
B
Division of Cardio-Thoracic Surgery, McGill University Health Center, Montreal, Quebec, Canada.
Haichin
R
R
D000368:Aged; D016022:Case-Control Studies; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011184:Postoperative Period; D013318:Stroke Volume / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*; D020257:Ventricular Remodeling / Q000502:physiology*