Limits...
Surgery of secondary mitral insufficiency in patients with impaired left ventricular function.

Rukosujew A, Klotz S, Welp H, Bruch C, Ghezelbash F, Schmidt C, Weber R, Hoffmeier A, Sindermann J, Scheld HH - J Cardiothorac Surg (2009)

Bottom Line: Three operative deaths (7.5%) occurred as a result of left ventricular failure in one and multiorgan failure in two patients.At a mean follow-up of 50 +/- 34 (2-112) months the NYHA class improved significantly from 3.2 +/- 0.5 to 2.2 +/- 0.4 (p < 0.001).High risk mitral valve surgery in patients with cardiomyopathy and SMI offers a real mid-term alternative method of treatment of patients in drug refractory heart failure with similar survival in comparison to heart transplantation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital Muenster, Germany. andreas.rukosujew@ukmuenster.de.

ABSTRACT

Background: Secondary mitral insufficiency (SMI) is an indicator of a poor prognosis in patients with ischemic and dilated cardiomyopathies. Numerous studies corroborated that mitral valve (MV) surgery improves survival and may be an alternative to heart transplantation in this group of patients.The aim of the study was to retrospectively analyze the early and mid-term clinical results after MV repair resp. replacement in patients with moderate-severe to severe SMI and left ventricular ejection fraction (LVEF) below 35%.

Methods: We investigated 40 patients with poor LVEF (mean, 28 +/- 5%) and SMI who underwent MV repair (n = 26) resp. replacement (n = 14) at the University Hospital Muenster from January 1994 to December 2005. All patients were on maximized heart failure medication. 6 pts. had prior coronary artery bypass grafts (CABG). Twenty-seven patients were in New York Heart Association (NYHA) class III and 13 were in class IV. Eight patients were initially considered for transplantation. During the operation, 14 pts had CABG for incidental disease and 8 had tricuspid valve repair. Follow-up included echocardiography, ECG, and physician's examination and was completed in 90% among survivors. Additionally, the late results were compared with the survival after orthotope heart transplantation (oHTX) in adults with ischemic or dilated cardiomyopathies matched to the same age and time period (148 patients).

Results: Three operative deaths (7.5%) occurred as a result of left ventricular failure in one and multiorgan failure in two patients. There were 14 late deaths, 2 to 67 months after MV procedure. Progress of heart failure was the main cause of death. 18 patients who were still alive took part on the follow-up examination. At a mean follow-up of 50 +/- 34 (2-112) months the NYHA class improved significantly from 3.2 +/- 0.5 to 2.2 +/- 0.4 (p < 0.001). The LVEF improved significantly from 29 +/- 5% to 39 +/- 16 (p < 0.05). There were no differences in survival after MV repair or replacement. The 1-, 3-, 5-year survival rates in the study group were 80%, 58% and 55% respectively. In the group of patients after oHTX the survival was accordingly 72%, 68%, 66% (p > 0.05).

Conclusion: High risk mitral valve surgery in patients with cardiomyopathy and SMI offers a real mid-term alternative method of treatment of patients in drug refractory heart failure with similar survival in comparison to heart transplantation.

Show MeSH

Related in: MedlinePlus

Kaplan – Meier survival curve in patients after MV reconstruction and MV replacement. Log Rank 0.541.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2721830&req=5

Figure 1: Kaplan – Meier survival curve in patients after MV reconstruction and MV replacement. Log Rank 0.541.

Mentions: The 1-, 3-, 5-year survival rates in the study group were 80%, 58% and 55% respectively. There were no differences in survival after MV repair or replacement (Fig. 1). Additionally we have compared the late results in the study group with the survival after cardiac transplantation in 148 age, gender and time-period matched patients with dilated and ischemic cardiomyopathy (Fig. 2). In this group the survival was accordingly 72%, 68%, 66% and similar to patients after MV surgery (p > 0.05).


Surgery of secondary mitral insufficiency in patients with impaired left ventricular function.

Rukosujew A, Klotz S, Welp H, Bruch C, Ghezelbash F, Schmidt C, Weber R, Hoffmeier A, Sindermann J, Scheld HH - J Cardiothorac Surg (2009)

Kaplan – Meier survival curve in patients after MV reconstruction and MV replacement. Log Rank 0.541.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2721830&req=5

Figure 1: Kaplan – Meier survival curve in patients after MV reconstruction and MV replacement. Log Rank 0.541.
Mentions: The 1-, 3-, 5-year survival rates in the study group were 80%, 58% and 55% respectively. There were no differences in survival after MV repair or replacement (Fig. 1). Additionally we have compared the late results in the study group with the survival after cardiac transplantation in 148 age, gender and time-period matched patients with dilated and ischemic cardiomyopathy (Fig. 2). In this group the survival was accordingly 72%, 68%, 66% and similar to patients after MV surgery (p > 0.05).

Bottom Line: Three operative deaths (7.5%) occurred as a result of left ventricular failure in one and multiorgan failure in two patients.At a mean follow-up of 50 +/- 34 (2-112) months the NYHA class improved significantly from 3.2 +/- 0.5 to 2.2 +/- 0.4 (p < 0.001).High risk mitral valve surgery in patients with cardiomyopathy and SMI offers a real mid-term alternative method of treatment of patients in drug refractory heart failure with similar survival in comparison to heart transplantation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital Muenster, Germany. andreas.rukosujew@ukmuenster.de.

ABSTRACT

Background: Secondary mitral insufficiency (SMI) is an indicator of a poor prognosis in patients with ischemic and dilated cardiomyopathies. Numerous studies corroborated that mitral valve (MV) surgery improves survival and may be an alternative to heart transplantation in this group of patients.The aim of the study was to retrospectively analyze the early and mid-term clinical results after MV repair resp. replacement in patients with moderate-severe to severe SMI and left ventricular ejection fraction (LVEF) below 35%.

Methods: We investigated 40 patients with poor LVEF (mean, 28 +/- 5%) and SMI who underwent MV repair (n = 26) resp. replacement (n = 14) at the University Hospital Muenster from January 1994 to December 2005. All patients were on maximized heart failure medication. 6 pts. had prior coronary artery bypass grafts (CABG). Twenty-seven patients were in New York Heart Association (NYHA) class III and 13 were in class IV. Eight patients were initially considered for transplantation. During the operation, 14 pts had CABG for incidental disease and 8 had tricuspid valve repair. Follow-up included echocardiography, ECG, and physician's examination and was completed in 90% among survivors. Additionally, the late results were compared with the survival after orthotope heart transplantation (oHTX) in adults with ischemic or dilated cardiomyopathies matched to the same age and time period (148 patients).

Results: Three operative deaths (7.5%) occurred as a result of left ventricular failure in one and multiorgan failure in two patients. There were 14 late deaths, 2 to 67 months after MV procedure. Progress of heart failure was the main cause of death. 18 patients who were still alive took part on the follow-up examination. At a mean follow-up of 50 +/- 34 (2-112) months the NYHA class improved significantly from 3.2 +/- 0.5 to 2.2 +/- 0.4 (p < 0.001). The LVEF improved significantly from 29 +/- 5% to 39 +/- 16 (p < 0.05). There were no differences in survival after MV repair or replacement. The 1-, 3-, 5-year survival rates in the study group were 80%, 58% and 55% respectively. In the group of patients after oHTX the survival was accordingly 72%, 68%, 66% (p > 0.05).

Conclusion: High risk mitral valve surgery in patients with cardiomyopathy and SMI offers a real mid-term alternative method of treatment of patients in drug refractory heart failure with similar survival in comparison to heart transplantation.

Show MeSH
Related in: MedlinePlus