title: Long-term follow-up of mitral valve repair: a single-center experience.
abstract: BACKGROUND
  Our aim was to conduct a long-term follow-up of patients after mitral valve repair for incompetence. We identified determinants for mortality and compared mortality with standardized mortality rates of the Dutch population.
  
  
  METHODS
  We included in this single-center retrospective study 119 patients operated from March 1976 to February 1981. Patients with previous mitral valve surgery, isolated mitral stenosis, and congenital heart disease were excluded. Routine echocardiography was performed every 6 to 12 months. The cumulative probability of survival was calculated (Kaplan-Meier). The variables that statistically significantly associated with mortality were selected for multivariate analysis. Maximum follow-up was 27 years and complete in 98%. Mean age was 49.4 years, and 55% were preoperatively in New York Heart Association (NYHA) class III. Concomitant cardiac procedures were performed in 49%.
  
  
  RESULTS
  The 30-day postoperative mortality was 6.7% and the 20-year overall mortality was 63%. The standardized mortality rate was 30%, which was based on survival rates of the general Dutch population. In 27 cases (22.7%), re-operation was performed. Independent predictors for mortality were, after univariate and multivariate analysis, concomitant coronary artery bypass grafting (p=0.002), renal impairment (p=0.027), age above 60 years (p=0.05), and ejection fraction<or=40% (p=0.05).
  
  
  CONCLUSIONS
  The observed mortality exceeded the expected mortality. Concomitant coronary artery bypass grafting, renal impairment, age above 60 years, and reduced left ventricular function were independent predictors of mortality in patients with surgical repair for mitral valve regurgitation.
authors.affiliation: Department of Cardio-thoracic Surgery and Cardiology, Sint Antonius Hospital Nieuwegein, and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands. g.m.m.shahin@isala.nl
authors.forename: Ghada M M
authors.initials: GM
authors.lastname: Shahin
authors.forename: Geert J M G
authors.initials: GJ
authors.lastname: van der Heijden
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Kelder
authors.forename: Mohamed
authors.initials: M
authors.lastname: Boulaksil
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Knaepen
authors.forename: A Jakob
authors.initials: AJ
authors.lastname: Six
mesh_terms: D002423:Cause of Death; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D008943:Mitral Valve / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000401:mortality / Q000601:surgery*; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis