Circulation, Vol 81, 1173-1181, Copyright © 1990 by American Heart Association
MH Crawford, J Souchek, CA Oprian, DC Miller, S Rahimtoola, JC Giacomini, G Sethi and KE Hammermeister
To determine how survival and clinical status were related to left
ventricular (LV) size and systolic function after mitral valve replacement,
104 patients (48 mitral regurgitation [MR], 33 mitral stenosis [MS], and 23
MS/MR) with isolated mitral valve replacement were evaluated before and
after surgery. Preoperative hemodynamic abnormalities by cardiac
catheterization were improved 6 months after surgery in all three patient
groups. The patients with MR exhibited reductions in LV end-diastolic
volume index (EDVI) (117 +/- 51 to 89 +/- 27 ml/m2, p less than 0.001) and
ejection fraction (EF) (0.56 +/- 0.15 to 0.45 +/- 0.13, p less than 0.001);
however, the ratio of forward stroke volume to end-diastolic volume
increased (0.32 +/- 0.21 to 0.45 +/- 0.17, p less than 0.001) because of
the elimination of regurgitant volume. Survival analysis revealed that
mortality was significantly higher in MS or MS/MR patients with
postoperative EDVI more than 101 ml/m2 (p less than 0.001 and p less than
0.042, respectively) and in MR patients with postoperative EF less than or
equal to 0.50 (p less than 0.031). Also, the majority of patients with MR
or MS/MR and postoperative EDVI more than 101 ml/m2 and EF less than or
equal to 0.50 were in New York Heart Association class III or IV.
Multivariate logistic regression analysis in the patients with MR revealed
that the strongest predictor of postoperative EF was preoperative EF (p
less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Determinants of survival and left ventricular performance after mitral valve replacement. Department of Veterans Affairs Cooperative Study on Valvular Heart Disease
Department of Medicine, University of New Mexico School of Medicine, Albuquerque 87131.
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