Efficacy of mitral valve replacement for patients with mitral regurgitation and a dilated left ventricle

Mitral regurgitation is a significant complication of end-stage cardiomyopa thy, and its existence predicts poor survival. In general, it is thought th at mitral valve replacement (MVR) alone is ineffective; however, there are few detailed reports of the clinical course of patients who have undergone MVR. Five patients with mitral regurgitation whose preoperative left ventri cular end-systolic volume index was more than 100 ml/m(2) were studied. Alt hough their prognosis late after MVR became poor, none of them died within 30 days of the operation. Postoperative cardiac catheterization was perform ed 6.3+/-1.1 months after surgery; the end-diastolic volume had reduced (be fore: 193+/-26 ml/m(2); after: 166+/-34 ml/m(2), p<0.05), but the end-systo lic volume had not (before: 110+/-7 ml/m(2); after: 112+/-32ml/m(2)). The e nd-systolic wall stress was substantially elevated preoperatively (238+/-29 kdyne/cm(2)) and tended to increase after surgery (295+/-96 kdyne/cm(2)). All the patients were able to return to work at some stage postoperatively (their New York Heart Association functional class improved to I or II), bu t 3 of the 5 patients died suddenly of heart failure at 3.3+/-1.6 years aft er surgery and the New York Heart Association functional class of the other s worsened to III again. Mitral valve surgery, including MVR, can manage se vere end-stage heart disease with mitral regurgitation.