title: Mitral regurgitation complicates postoperative outcome of noncardiac surgery.
abstract: BACKGROUND
  Whether and how mitral regurgitation impacts perioperative outcome of noncardiac surgery remains unclear.
  
  
  METHODS
  From November 1999 to August 2004, all patients undergoing noncardiac operations and ever examined by echocardiography within prior 12 months were screened. Those with moderate-severe or severe mitral regurgitation were enrolled provided they were not already trachea-intubated and the surgery was not performed under local anesthesia. The perioperative outcomes of these patients were analyzed, and related prognostic predictors were investigated by multivariate logistic regression analysis.
  
  
  RESULTS
  A total of 84 patients (43 men, mean age of 66 years, low surgical risk in 28 and intermediate in 56) complying with the inclusion criteria were included. Their surgery was complicated by frequent (31%) yet minor intraoperative adverse events of controllable hypotension and bradycardia. In contrast, the postoperative outcomes were seriously complicated with high morbidity (27.4%, mostly pulmonary edema and prolonged tracheal intubation) and mortality (11.9%). Atrial fibrillation was identified by multivariate logistic regression analysis as the predictor of inhospital death (OD 11.579, P = .003), whereas surgical risk level (OD 5.118, P = .021), left ventricular ejection fraction (OD 0.958, P = .026), and atrial fibrillation (OD 3.058, P = .045), as independent predictors of postoperative morbidity.
  
  
  CONCLUSIONS
  Under current anesthetic management, patients with advanced mitral regurgitation could go through fairly safe intraoperative course of noncardiac surgery despite minor complications. Their postoperative outcome was, however, complicated by extraordinarily high morbidity and mortality, especially in those with preexisting atrial fibrillation, higher surgical risk level, and lower left ventricular ejection fraction.
authors: Department of Anesthesiology and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.
authors: Hui-Chin
authors: HC
authors: Lai
authors: Hui-Chun
authors: HC
authors: Lai
authors: Wen-Lieng
authors: WL
authors: Lee
authors: Kuo-Yang
authors: KY
authors: Wang
authors: Chih-Tai
authors: CT
authors: Ting
authors: Tsun-Jui
authors: TJ
authors: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors