Isolated mitral valve repair in patients with depressed left ventricular function

Abstract

Background: The utility of mitral valve repair (MV repair) has been well documented in patients with normal left ventricular function. Few studies, however, have specifically examined outcomes of isolated MV repair in patients with decreased left ventricular function. The purpose of the present study is to review a modern experience with isolated MV repair in patients with depressed left ventricular function and to examine intermediate outcomes.

Methods: A retrospective review of patients who underwent MV repair from 1996 to 2003 was performed to identify consecutive patients who had isolated MV repair. Preoperative studies were reviewed to further identify patients with an ejection fraction less than 0.45. Clinical operative data were collected from the medical record, and survival was determined with the Social Security Death Index. Further end points of reoperation and transplantation were also noted.

Results: A total of 101 patients were identified with a mean follow-up of 1,124 days. Mean ejection fraction and age was 0.34 +/- 0.09 and 56 +/- 14 years, respectively. Thirty-day mortality was 2.9%. One- and 5-year survival was 94% +/- 2% and 70% +/- 6%, respectively. There was no statistically significant difference in actuarial survival for functional versus primary mitral disease, or for ejection fraction less than 0.35 versus greater than 0.35. Six patients required transplantation. Five-year freedom from reoperation, transplantation, and death was 61% +/- 11% and 54% +/- 8% for patients with primary and secondary mitral valve disease, respectively (p = 0.279). Minimally invasive MV repair was performed in 57 patients with a mean ejection fraction of 0.369 +/- 0.07 and a 30-day mortality of 1.7%.

Conclusions: In patients with isolated MV regurgitation and depressed left ventricular function, MV repair can be achieved with low operative mortality, but there remains a persistent risk of death, reoperation, or transplantation irrespective of valve disease. Minimally invasive MV repair was safe in this group.