J. Fix et al., DO PATIENTS WITH LESS-THAN ECHO-PERFECT RESULTS FROM MITRAL-VALVE REPAIR BY INTRAOPERATIVE ECHOCARDIOGRAPHY HAVE A DIFFERENT OUTCOME, Circulation, 88(5), 1993, pp. 39-48
Background. Not all valve repairs for mitral regurgitation (MR) have a
perfect result, with no MR on postpump intraoperative echocardiograph
y. Although more than 2+ MR by postpump echocardiography has led to se
cond pump runs for further surgery in 6% to 8% of our patients, those
left with 1+ or 2+ MR, traditionally an acceptable result, have not pr
eviously been evaluated for clinical outcome. Methods and Results. Amo
ng 530 patients undergoing mitral repair during 1987 to 1989, 76 patie
nts with 1+ or 2+ MR by postpump intraoperative echocardiography were
compared with 76 patients who had equivalent age, sex, left ventricula
r function, and concomitant surgery but who had no MR by postpump echo
. In-hospital morbidity measured by the frequency of respiratory compl
ications, strokes, time in intensive care unit, and duration of hospit
al stay was actually higher in the patients with no MR after repair. H
ospital mortality was not significantly different. There were no signi
ficant differences in posthospital mortality (4-year survival estimate
of 86% in both groups), thromboembolic events, hospitalizations for h
eart failure, or functional class, although more patients in the group
with no MR after repair were using diuretics. There was a trend towar
d more reoperations in patients with 1+ or 2+ MR compared with those w
ith no MR by intraoperative echocardiography after repair (4-year esti
mates of freedom from reoperation, 83% versus 94%; adjusted risk ratio
, 3.30). Conclusions. The presence of 1+ or 2+ MR by postpump intraope
rative echocardiography does not confer increased morbidity or mortali
ty. However, the trend toward more reoperations suggests the need for
close follow-up for possible recurrence of MR. These data support our
low threshold for performing further surgery during second pump runs.