title: Does early surgical intervention improve left ventricular mass regression after mitral valve repair for leaflet prolapse?
abstract: BACKGROUND
  Left ventricular hypertrophy is associated with adverse cardiovascular outcomes. It is unclear whether hypertrophy caused by severe chronic mitral regurgitation regresses after mitral valve repair and, if so, which factors promote reverse remodeling and influence its prognostic significance.
  
  
  METHODS
  Between March 1995 and December 2005, 2589 patients had mitral valve repair. Five hundred thirty patients (346 of whom were male) underwent isolated repair for leaflet prolapse and had echocardiographic data available from which the left ventricular mass index could be calculated. Concomitant preoperative tricuspid valve regurgitation was more than mild in 95 (18%) patients. Those with preoperative atrial fibrillation and other cardiac pathologies necessitating intracardiac repair were not included.
  
  
  RESULTS
  Significant regression of left ventricular mass index occurred during the first 3 years (-28 g/m(2), P < .001) and was maintained during follow-up for more than 3 years (-26 g/m(2), P < .001). Higher preoperative left ventricular ejection fraction and greater preoperative left ventricular mass index independently predicted improved left ventricular mass index regression at 3 years. During follow-up of greater than 3 years, greater preoperative left ventricular mass index persisted in predicting improved mass regression (P < 0.001), and greater than mild preoperative tricuspid valve regurgitation was associated with less mass regression (P < .001). Late recovery of normal left ventricular ejection fraction was impaired in those with the greatest residual left ventricular mass; however, there was no difference in late symptoms or survival.
  
  
  CONCLUSIONS
  Performing mitral valve repair before a decrease in left ventricular ejection fraction and the development of significant secondary tricuspid valve regurgitation is associated with a greater likelihood of significant regression of left ventricular mass, possibly predicting improved recovery of normal left ventricular function after surgical intervention. These data provide additional support for early degenerative mitral valve repair.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minn, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Stulak
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.forename: Harold M
authors.initials: HM
authors.lastname: Burkhart
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
authors.forename: Maurice
authors.initials: M
authors.lastname: Enriquez-Sarano
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D015150:Echocardiography, Doppler; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D008945:Mitral Valve Prolapse / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000209:etiology; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling; D055815:Young Adult