title: Predicting early left ventricular dysfunction after mitral valve reconstruction: the effect of atrial fibrillation and pulmonary hypertension.
abstract: OBJECTIVE
  The preoperative ejection fraction (EF) and left ventricular (LV) end-systolic dimension are known predictors of postoperative LV dysfunction after mitral valve repair. We investigated the effect of a preoperative history of atrial fibrillation and moderate pulmonary hypertension (defined as pulmonary artery systolic pressure >50 mm Hg) on early postoperative LV dysfunction.
  
  
  METHODS
  From 2003 to 2010, 632 patients who had undergone successful mitral valve repair surgery for degenerative disease were included in the present study. The preoperative and postoperative echocardiographic data and postoperative outcomes were collected retrospectively. We analyzed the demographic, hemodynamic, and echocardiographic parameters to assess the predictors of early postoperative LV dysfunction, defined as an LVEF <50%.
  
  
  RESULTS
  The mean age of the cohort was 57 ± 13 years. All patients had less than mild mitral regurgitation on postoperative echocardiography. After mitral valve repair, a significant decrease in the LVEF (60% ± 8% to 54% ± 9%), LV end-systolic diameter (36 ± 7 mm to 33 ± 7 mm), and LV end-diastolic dimension (56 ± 8 mm to 48 ± 7 mm) was observed at early postoperative echocardiography (P < .001). On multivariate regression analysis, preoperative atrial fibrillation, pulmonary hypertension, and LV end-systolic dimension were independent predictors of the postoperative LVEF (P = .035 and P < .001, respectively). Preoperative atrial fibrillation (odds ratio, 1.97; 95% confidence interval, 1.28-3.02; P = .002) and pulmonary artery systolic pressure >50 mm Hg (odds ratio, 1.82; 95% confidence interval, 1.11-2.97; P = .017) increased the risk of postoperative LV dysfunction by almost twofold.
  
  
  CONCLUSIONS
  In addition to the established predictors of postoperative LV dysfunction, the presence of preoperative pulmonary hypertension and a history of atrial fibrillation in patients undergoing mitral valve repair surgery increased the risk of early postoperative LV dysfunction by almost twofold.
authors.affiliation: Department of Cardiothoracic Surgery, Icahn School of Medicine, Mount Sinai Medical Center, New York, NY. Electronic address: robin.varghese@mountsinai.org.
authors.forename: Robin
authors.initials: R
authors.lastname: Varghese
authors.affiliation: Department of Cardiothoracic Surgery, Icahn School of Medicine, Mount Sinai Medical Center, New York, NY.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Itagaki
authors.affiliation: Department of Cardiothoracic Surgery, Icahn School of Medicine, Mount Sinai Medical Center, New York, NY.
authors.forename: Anelechi C
authors.initials: AC
authors.lastname: Anyanwu
authors.affiliation: Department of Cardiothoracic Surgery, Icahn School of Medicine, Mount Sinai Medical Center, New York, NY.
authors.forename: Federico
authors.initials: F
authors.lastname: Milla
authors.affiliation: Department of Cardiothoracic Surgery, Icahn School of Medicine, Mount Sinai Medical Center, New York, NY.
authors.forename: David H
authors.initials: DH
authors.lastname: Adams
mesh_terms: D000328:Adult; D000368:Aged; D062186:Arterial Pressure; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016009:Chi-Square Distribution; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D015999:Multivariate Analysis; D016017:Odds Ratio; D011651:Pulmonary Artery / Q000503:physiopathology; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016277:Ventricular Function, Left