Preoperative predictors of late postoperative outcome among patients with nonischemic mitral regurgitation with 'high risk' descriptors and comparison with unoperated patients

Among patients with chronic nonischemic mitral regurgitation (MR), high sho rt-term mortality risk can be identified by left (LV) and/or right ventricu lar (RV) ejection fraction (EF) criteria (LVEF less than or equal to 45% an d/or RVEF less than or equal to 30%). Mitral valve replacement or repair (M VR) significantly improves outcome in this subgroup, but predictors of late postoperative survival are not known, and the benefit of MVR has not been defined in patients matched for severity of LV and RV dysfunction. Therefor e, prospective assessment of 14 consecutive high risk MR patients was perfo rmed before MVR and during 9 years (average) postoperatively to define echo cardiographic and radionuclide angiographic predictors of survival; surviva l also was evaluated in a contemporaneous series of 9 high risk unoperated MR patients, and in subgroups of operated and unoperated patients matched f or EF. Of 14 MVR patients, 4 died (3 cardiac: 1 sudden, 2 congestive heart failure). Only preoperative RVEF less than or equal to 20% significantly pr edieted postoperative deaths (rest p = 0.032; exercise p = 0.05). Of 9 unop erated patients, 8 died. Mortality risk of unoperated patients remained hig her than that of MVR patients when groups were matched for preoperative LVE F (p = 0.0001). Among patients with RVEF > 20%, MVR significantly improved survival versus medical treatment (rest: p < 0.0001, exercise: p = 0.0003). In high risk MR patients, MVR improves survival; preoperative RV performan ce can define subgroups with different long-term postoperative survival. Co pyright (C) 2000 S. Karger AG, Basel.