Echocardiographic prediction ofleft ventricular dysfunction aftermitral valve repair for mitral regurgitation as anindicator to decide the optimal timing of repair

OBJECTIVES This study sought to determine whether echocardiography before mitral valve repair (MVR) for mitral regurgitation (MR) was predictive of postoperative left ventricular (LV) dysfunction and useful for deciding the optimal timing of repair. BACKGROUND Some reports have shown that the preoperative echocardiographic data of left ventricular ejection fraction (LVEF) and left ventricular end-systolic diameter (LVDs) were good predictors of postoperative LV dysfunction. However, few reports were based on long-term follow-up data of large numbers of patients who underwent MVR in the last decade. METHODS A total of 274 patients with moderate or severe MR underwent MVR between October 1, 1991, and September 30, 2000. Among them, 171 patients who had both an operation for isolated MR due to degenerative pathology and a postoperative echocardiogram were studied. Postoperative echocardiograms were performed 3.9 2.4 years after the operation. RESULTS The LVEF decreased from 66 10% before surgery to 63 11% after surgery (p 0.0001). On univariate analysis, preoperative LVEF and LVDs correlated with postoperative LVEF (r 0.41 and r 0.39, respectively). Overall, postoperative LV dysfunction (defined as LVEF 50%) was not frequent (12%). However, the incidence of postoperative LV dysfunction was high in patients with preoperative LVEF 55% (38%) or LVDs 40 mm (23%). CONCLUSIONS In patients with MR, the echocardiographic data of LVEF and LVDs were good predictors of postoperative LV dysfunction. When a decrease in LVEF or an increase in LVDs is detected, MVR should be considered to preserve postoperative LV function. (J Am Coll Cardiol 2003;42:458 – 63) © 2003 by the American College of Cardiology Foundation The effectiveness of mitral valve repair (MVR) for patients with mitral regurgitation (MR) is well established (1– 8). This advent has led to earlier surgical intervention to correct MR, because deferring surgery until the patient becomes symptomatic or manifests overt left ventricular (LV) dysfunction often leads to irreversible LV dysfunction after the operation (3,6,8 –11). See page 464