Clinical Outcomes After Durable Mitral Valve Repair for Ischemic Mitral Regurgitation
| Autor: | Satoshi Kainuma, Yusuke Misumi, Koichi Toda, Yoshiki Sawa, Daisuke Yoshioka, Ai Kawamura, Takuji Kawamura, Toru Kuratani, Kazuhiro Taniguchi, Noriyuki Kashiyama, Sho Komukai, Takayoshi Ueno, Tetsuhisa Kitamura, Mikiko Senzai, Shigeru Miyagawa |
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| Rok vydání: | 2022 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Mitral Valve Annuloplasty medicine.medical_treatment Inferior vena cava Ventricular Function Left Internal medicine medicine.artery medicine Humans Heart Failure Mitral regurgitation Mitral valve repair Ejection fraction Ischemic cardiomyopathy business.industry Hazard ratio Mitral Valve Insufficiency Stroke Volume medicine.disease Treatment Outcome medicine.vein Heart failure Pulmonary artery Cardiology Mitral Valve Surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of Thoracic Surgery. 114:115-124 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2021.08.016 |
| Popis: | Background This study aimed to clarify the incidence and determinants of postoperative adverse events in patients with ischemic cardiomyopathy who achieved long-term durable mitral valve repair. Methods Between 1999 and 2015, 166 patients with chronic ischemic mitral regurgitation (MR) and left ventricular (LV) ejection fraction ≤40% underwent restrictive mitral annuloplasty. During follow-up (65±34 months), echocardiographic assessments were performed 809 times (mean, 4.9±2.4 times) and 20 patients who had developed postoperative recurrent MR (≥moderate) were excluded. Finally, 146 patients (68±9 years) whose MR was well controlled over time were included. Results A total of 61 mortalities and/or 27 readmissions for heart failure were observed in 76 patients (52%). Among hospital survivors, age (adjusted hazard ratio: 1.05; P=0.001), and estimated glomerular filtration rate (adjusted hazard ratio: 0.61; P=0.001) were identified as independent predictors of long-term mortality and/or readmission for heart failure. The degree of LV function recovery after surgery was comparable between patients with and without adverse events. However, the former group showed greater values for systolic pulmonary artery pressure, tricuspid regurgitation severity, inferior vena cava dimension, and plasma brain natriuretic peptide level throughout the follow-up period (group effect p Conclusions Approximately 50% of patients died or were hospitalized for heart failure even in the absence of recurrent mitral regurgitation during the 5-year follow-up, indicating that durable mitral repair does not always lead to favorable clinical outcomes. The adverse events might be related to volume overload secondary to impaired renal function and less favorable pulmonary hemodynamics. |
| Databáze: | OpenAIRE |
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