title: The effect of mitral valve surgery on ventricular arrhythmia in patients with bileaflet mitral valve prolapse.
abstract: BACKGROUND
  Bileaflet mitral valve prolapse (biMVP) is associated with frequent ventricular ectopy (VE) and malignant ventricular arrhythmia. We examined the effect of mitral valve (MV) surgery on VE burden in biMVP patients.
  
  
  METHODS
  We included 32 consecutive patients undergoing MV surgery for mitral regurgitation secondary to biMVP between 1993 and 2012 at Mayo Clinic who had available pre- and post-operative Holter monitoring data. Characteristics of patients with a significant reduction in postoperative VE (group A, defined as >10% reduction in VE burden compared to baseline) were compared with the rest of study patients (group B).
  
  
  RESULTS
  In the overall cohort, VE burden was unchanged after the surgery (41 interquartile range [16, 196] pre-surgery vs. 40 interquartile range [5186] beats/hour [bph] post-surgery; P = 0.34). However, in 17 patients (53.1%), VE burden decreased by at least 10% after the surgery. These patients (group A) were younger than the group B (59 ± 15 vs. 68 ± 7 years; P = 0.04). Other characteristics including pre- and postoperative left ventricular function and size were similar in both groups. Age <60 years was associated with a reduction in postoperative VE (odds ratio 5.8; 95% confidence interval, 1.1-44.7; P = 0.03). Furthermore, there was a graded relationship between age and odds of VE reduction with surgery (odds ratio 1.9; 95% confidence interval 1.04-4.3 per 10-year; P = 0.04).
  
  
  CONCLUSIONS
  MV surgery does not uniformly reduce VE burden in patients with biMVP. However, those patients who do have a reduction in VE burden are younger, perhaps suggesting that early surgical intervention could modify the underlying electrophysiologic substrate.
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Niyada
authors.initials: N
authors.lastname: Naksuk
authors.affiliation: Division of Internal Medicine Cardiology, Medical School, University of Michigan, 500 S. State Street, Ann Arbor, MI 48109, USA.
authors.forename: Faisal F
authors.initials: FF
authors.lastname: Syed
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Chayakrit
authors.initials: C
authors.lastname: Krittanawong
authors.affiliation: Deapartment of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Anderson
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza, University of Turin, Corso Bramante, 88, 10126 Turin, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Ebrille
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Christopher V
authors.initials: CV
authors.lastname: DeSimone
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Vaibhav R
authors.initials: VR
authors.lastname: Vaidya
authors.affiliation: Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic Health System - Albert Lea and Austin, 1000 First Drive NW, Austin, MN 55912, USA.
authors.forename: Shiva P
authors.initials: SP
authors.lastname: Ponamgi
authors.affiliation: Department of Cardiovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ackerman
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Vuyisile T
authors.initials: VT
authors.lastname: Nkomo
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Electronic address: noseworthy.peter@mayo.edu.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Noseworthy
keywords: Bileaflet mitral valve prolapse; Mitral valve surgery; Papillary ventricular arrhythmias; Sudden cardiac death; Ventricular arrhythmias; Ventricular ectopy