title: Preoperative risk factors of medium-term mitral valve repair outcome.
abstract: OBJECTIVE
  This study aimed to evaluate risk factors that affect mitral valve (MV) repair outcomes.
  
  
  METHODS
  From 2002 to 2012, 580 consecutive patients with mitral regurgitation (MR) underwent MV repair. Of the total number of patients, 48.9% were found to be in New York Heart Association (NYHA) Class III or IV. Anterior, posterior and bileaflet prolapse was present in 34.8, 47.6 and 17.6% of patients, respectively. Atrial fibrillation (AF) was found in 29.7% of patients. The mean follow-up was 5.3 ± 2.6 years.
  
  
  RESULTS
  There were eight early and 14 late deaths. NYHA Class III/IV, left ventricular ejection fraction ≤50%, systolic pulmonary artery pressure ≥50 mmHg, AF and low cardiac output syndrome with extracorporeal membrane oxygen were independent predictors of early mortality. AF, NYHA Class III/IV, left ventricular end-systolic diameter ≥40 mm and systolic pulmonary artery pressure ≥50 mmHg remained predictors of late mortality. At 5 years, the rate of survival, freedom from reoperation and recurrent moderate to severe MR was 99.0 ± 0.6 97.2 ± 0.8 and 93.3 ± 1.2%, respectively. Anterior leaflet involvement was predictive of reoperation and recurrent moderate to severe MR. In patients with a moderate tricuspid regurgitation (TR) and annulus <40 mm, the degree of TR during follow-up was worse with right ventricular dilatation.
  
  
  CONCLUSIONS
  MV repair should be performed before the deterioration of ventricular function, development of pulmonary hypertension and AF occurrence. The pathophysiology of MR affects MV repair durability, while concomitant tricuspid annuloplasty should be considered in patients with moderate TR despite annular dilatation.
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China wangjiangang7545@126.com.
authors.forename: Jiangang
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Han
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Chunlei
authors.initials: C
authors.lastname: Xu
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Jiao
authors.affiliation: University of Michigan Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Bo
authors.initials: B
authors.lastname: Yang
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Meng
authors.affiliation: University of Michigan Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Steven F
authors.initials: SF
authors.lastname: Bolling
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D055815:Young Adult
keywords: Atrial fibrillation; Mitral regurgitation; Mitral valve; Mitral valve repair; Tricuspid valve