Long-term outcome after mitral valve repair: a risk factor analysis

Details

Ressource 1Download: serval:BIB_DAA95BF8DE0B.P001 (205.62 [Ko])
State: Public
Version: author
License: Not specified
It was possible to publish this article open access thanks to a Swiss National Licence with the publisher.
Serval ID
serval:BIB_DAA95BF8DE0B
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Long-term outcome after mitral valve repair: a risk factor analysis
Journal
European Journal of Cardio-Thoracic Surgery
Author(s)
Meyer  M. A., von Segesser  L. K., Hurni  M., Stumpe  F., Eisa  K., Ruchat  P.
ISSN
1010-7940 (Print)
Publication state
Published
Issued date
08/2007
Volume
32
Number
2
Pages
301-7
Notes
Journal Article --- Old month value: Aug
Abstract
OBJECTIVE: Mitral valve repair is the gold standard to restore mitral valve function and is now known to have good long-term outcome. In order to help perioperative decision making, we analyzed our collective to find independent risk factors affecting their outcome. METHODS: We retrospectively studied our first 175 consecutive adult patients (mean age: 64+/-10.4 years; 113 males) who underwent primary mitral valve repair associated with any other cardiac procedures between January 1986 and December 1998. Risk factors influencing reoperations and late survival were plotted in a uni- and multivariate analyses. RESULTS: Operative mortality was 3.4% (6 deaths, 0-22nd postoperative day (POD)). Late mortality was 9.1% (16 deaths, 3rd-125th POM). Reoperation was required in five patients. Kaplan-Meier actuarial analysis demonstrated a 96+/-1% 1-year survival, 88+/-3% 5-year survival and a 69+/-8% 10-year survival. Freedom from reoperations was 99% at 1 year after repair, 97+/-2% after 5 years and 88+/-6% after 10 years. Multivariate analysis demonstrated that residual NYHA class III and IV (p=0.001, RR 4.55, 95% CI: 1.85-14.29), poor preoperative ejection fraction (p=0.013, RR 1.09, 95% CI: 1.02-1.18), functional MR (p=0.018, RR 4.17, 95% CI: 1.32-16.67), and ischemic MR (p=0.049, RR 3.13, 95% CI: 1.01-10.0) were all independent predictors of late death. Persistent mitral regurgitation at seventh POD (p=0.005, RR 4.55, 95% CI: 1.56-20.0), age below 60 (p=0.012, RR 8.7, 95% CI: 2.44-37.8), and absence of prosthetic ring (p=0.034, RR 4.76, 95% CI: 1.79-33.3) were all independent risk factors for reoperation. CONCLUSIONS: Mitral valve repair provides excellent survival. However, long-term outcome can be negatively influenced by perioperative risk factors. Risk of reoperation is higher in younger patients with a residual mitral regurgitation and without ring annuloplasty.
Keywords
Adult Age Factors Aged Aged, 80 and over Cardiac Surgical Procedures/methods Female Humans Kaplan-Meiers Estimate Male Middle Aged Mitral Valve/physiopathology/*surgery Mitral Valve Insufficiency/etiology/mortality/*surgery Postoperative Complications Reoperation Retrospective Studies Risk Factors Time Factors Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
28/01/2008 10:39
Last modification date
25/09/2019 7:10
Usage data