title: Mitral valve surgery in patients with poor left ventricular function.
abstract: BACKGROUND
  Mitral valve surgery for the correction of secondary mitral valve regurgitation (MR) in cardiomyopathy is associated with a poor outcome. Numerous studies have identified a severe left ventricular dysfunction as an indicator for a poor prognosis. The aim of the study was to asses the follow-up after mitral valve surgery and severe left ventricular dysfunction.
  
  
  METHODS
  Between 1994 and 2000, 31 patients with mitral regurgitation and a left ventricular ejection fraction of below thirty percent undergoing isolated repair (n = 16) or replacement (n = 15) were investigated. All patients received maximal drug therapy. Twenty-one patients were New York Heart Association (NYHA) class III and 10 were class IV. Follow-up with echocardiography, ECG, and chest x-ray was performed in 87 % of the survivors. The mean duration of follow-up was 39 +/- 16 months.
  
  
  RESULTS
  The mean duration of ICU and hospital stay was 3.6 +/- 2.1 days and 8.1 +/- 5.4 days, respectively. The 1-, 2-, and 5-year survival rates were 91 %, 84 %, and 77 %, respectively. NYHA class improved from 3.3 +/- 0.8 to 2.1 +/- 0.7 at follow-up (p < 0.01). The ejection fraction improved from 23.1 +/- 6.6 % to 36 +/- 6.8 % at follow-up (p < 0.02). Freedom from readmission for heart failure was 85 %, 79 %, and 68 % at 1-, 2-, and 5 years, respectively.
  
  
  CONCLUSIONS
  Mitral valve surgery improves left ventricular function and reduces heart failure severity in patients with MR and cardiomyopathy. High-risk mitral valve surgery may be an alternative to heart transplantation in selected patients.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital Muenster, Germany. markus.rothenburger@thgms.uni-muenster.de
authors.forename: M
authors.initials: M
authors.lastname: Rothenburger
authors.forename: A
authors.initials: A
authors.lastname: Rukosujew
authors.forename: D
authors.initials: D
authors.lastname: Hammel
authors.forename: A
authors.initials: A
authors.lastname: Dorenkamp
authors.forename: C
authors.initials: C
authors.lastname: Schmidt
authors.forename: C
authors.initials: C
authors.lastname: Schmid
authors.forename: T
authors.initials: T
authors.lastname: Wichter
authors.forename: H H
authors.initials: HH
authors.lastname: Scheld
mesh_terms: D001281:Atrial Fibrillation / Q000209:etiology; D001026:Coronary Artery Bypass; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology