Factors influencing survival and postoperative quality of life after mitral valve reconstruction.
OBJECTIVE
Mitral valve reconstruction (MVR) is the preferred treatment for regurgitant lesions. Clinical benefit is well documented, but comparative data scrutinising factors influencing survival and postoperative quality of life (QOL) in different subsets of patients are missing. We hypothesised that mitral valve reconstruction for mitral regurgitation benefits the patients, regardless of the valve pathology.


METHODS
In this study, 663 consecutive patients undergoing mitral valve reconstruction using Carpentier techniques were assigned to four different groups. Aetiology of mitral regurgitation was degenerative (DEG) in 372 (56.1%) patients and ischaemic (ISC) in 157 (23.6%). Cardiomyopathy (CMP) was present in 23 (3.4%) cases and combined degenerative regurgitation plus coronary artery disease (DEG+CAD) in 111 (16.7%) patients. Survival was evaluated using a Cox proportional hazards model. Postoperative QOL was assessed using the short form (SF)-36 questionnaire in a multivariate analysis of covariance.


RESULTS
The overall 30-day mortality was 1.1% (0.3%, 1.9%, 0% and 2.7% for groups DEG, ISC, CMP and DEG+CAD, respectively). The median preoperative NYHA class and grade MI was 3 and evenly distributed between groups. After a mean follow-up of 4.1+/-3.4 years, MVR proved to be effective in all groups with 90.3% of patients in the NYHA classes I and II (p<0.001). At 5 years, unadjusted survival was 90.3%, 69.7%, 50.5% and 86.2%. However, after correcting for age, ejection fraction, chronic obstructive pulmonary disorder (COPD), renal insufficiency and the preoperative NYHA class, survival in groups ISC and DEG+CAD was comparable. Group allocation was not a predictor for late death. Postoperative QOL was inferior in female patients in all SF-36 scales (p<0.01) and was impaired by co-morbidities. QOL scores were best for patients in group DEG and worst in group CMP. In a multivariate model correcting for gender, age and co-morbidities (COPD, treated diabetes, renal insufficiency, subjective heart rhythm, preoperative NYHA class and previous myocardial infarction), postoperative QOL was comparable between groups. For the majority of patients with degenerative MR, postoperative life expectancy as well as QOL is similar to a normal population.


CONCLUSIONS
MVR was safely and effectively accomplished in all groups. Survival and postoperative QOL was determined by left ventricular function and co-morbidities rather than MR aetiology.
Hansen
Lorenz
L
Albertinen-Krankenhaus, Hamburg, Germany. lorenz.hansen@albertinen.de
Winkel
Stephan
S
Kuhr
Jannick
J
Bader
Ralf
R
Bleese
Niels
N
Riess
Friedrich-Christian
FC
D000368:Aged; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D011594:Psychometrics; D011788:Quality of Life; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology