Does the Severity of Preoperative Symptoms Predict Operative Risk in Mitral Regurgitation?

pp. 101-107

Abstract

Background

Patients with severe degenerative mitral regurgitation (SDMR) referred to surgery present diverse clinical presentations; while some patients are asymptomatic with preserved ventricular function, others have functional class IV dyspnea and systolic dysfunction. Current guidelines are helpful to recognize timing of mitral valve surgery; however, reality is sometimes far from ideal and defines daily practice.

Objective

To analyze the impact of preoperative functional class (FC) on in-hospital and on long-term outcomes of patients undergoing surgery for SDMR.

Material and Methods

We conducted a retrospective analysis of 254 consecutive patients who underwent surgery due to SDMR between July 1997 and July 2007. Patients were divided into two groups according to their NYHA FC for dyspnea. Group 1 included 87 patients in FC I-II and group 2 included 167 patients in FC III-IV.

Results

Patients in group 1 were more likely to undergo mitral valve repair (56.3% versus 37.7%; p=0.005); conversely, associated myocardial revascularization was less frequent (10.3% versus 27.5%; p=0.002). During postoperative, patients in group 2 presented greater morbidity and mortality rates (27.5% versus 13.7%; p=0.01) and greater in-hospital mortality (9.5% versus 2.3%; p=0.03). Global actuarial survival at 10 years was 92.9% with a median follow-up of 1,182 days/ patient. During long-term follow-up, more patients in group 1 were free of associated events (mortality and readmission) than subjects in group 2 (HR 3.3; p=0.01, 95% CI 1.27-8.99). The degree of preoperative dyspnea was an independent predictor of adverse outcomes in multivariate analysis. The sub-analysis of patients without coronary artery disease also demonstrated that the severity of preoperative dyspnea is an independent predictor of in-hospital and long-term morbidity and mortality.

Conclusion

In patients with SDMR, preoperative FC III-IV dyspnea is associated with worse outcomes during hospitalization and long-term follow-up.