Indication of Mitral Valve Surgery in Advanced Non-ischemic Dilated Cardiomyopathy with Mitral Regurgitation

Abstract

BackgroundAlthough some patients with non-ischemic dilated cardiomyopathy (NIDCM) received mitral valve (MV) surgery show deterioration of cardiac function or poor prognosis after surgery, how to select appropriate patients for this treatment have still been under discussion. We investigated which parameters predict early and mid-term outcome after surgery in advanced NIDCM with mitral regurgitation (MR).MethodsFrom September 2005 to April 2014, 27 NIDCM (LVEF<35%) with MR underwent MV surgery, 15 repair and 12 replacement. Pre- and postoperative echocardiography and right heart catherterization were done and postoperative outcome were analyzed.ResultsMean follow-up duration was 25±24 months. Three hospital deaths and 2 left ventricular assist device (LVAD) implantations occurred during hospitalization. Three-year freedom from MACE was 46.8%. NYHA functional class significantly improved (3.3±0.6 to 2.2±0.6, p<0.0001), LVESVI (158±40 to 134±39 ml/m2, p<0.001) and pulmonary vascular resistance (PVR) (213±137 to 149±79 dynes/s/cm5, p<0.04) significantly decreased, and LV stroke work index (LVSWI) (20.7±7.0 to 23.98±4.8 mmHg×mL/m2) modestly increased after surgery. Preoperative low LVSWI and high PVR were significant predictors for hospital mortality and LVAD implantation (p<0.0001, p=0.04, respectively) and early and mid-term MACE (p<0.02, p<0.02, respectively).ConclusionsMV surgery can improve early postoperative functional status and cardiac function in selected patients with advanced NIDCM. Preoperative LVSWI and PVR can be helpful to decide indication of MV surgery and predict postoperative clinical outcome. BackgroundAlthough some patients with non-ischemic dilated cardiomyopathy (NIDCM) received mitral valve (MV) surgery show deterioration of cardiac function or poor prognosis after surgery, how to select appropriate patients for this treatment have still been under discussion. We investigated which parameters predict early and mid-term outcome after surgery in advanced NIDCM with mitral regurgitation (MR). Although some patients with non-ischemic dilated cardiomyopathy (NIDCM) received mitral valve (MV) surgery show deterioration of cardiac function or poor prognosis after surgery, how to select appropriate patients for this treatment have still been under discussion. We investigated which parameters predict early and mid-term outcome after surgery in advanced NIDCM with mitral regurgitation (MR). MethodsFrom September 2005 to April 2014, 27 NIDCM (LVEF<35%) with MR underwent MV surgery, 15 repair and 12 replacement. Pre- and postoperative echocardiography and right heart catherterization were done and postoperative outcome were analyzed. From September 2005 to April 2014, 27 NIDCM (LVEF<35%) with MR underwent MV surgery, 15 repair and 12 replacement. Pre- and postoperative echocardiography and right heart catherterization were done and postoperative outcome were analyzed. ResultsMean follow-up duration was 25±24 months. Three hospital deaths and 2 left ventricular assist device (LVAD) implantations occurred during hospitalization. Three-year freedom from MACE was 46.8%. NYHA functional class significantly improved (3.3±0.6 to 2.2±0.6, p<0.0001), LVESVI (158±40 to 134±39 ml/m2, p<0.001) and pulmonary vascular resistance (PVR) (213±137 to 149±79 dynes/s/cm5, p<0.04) significantly decreased, and LV stroke work index (LVSWI) (20.7±7.0 to 23.98±4.8 mmHg×mL/m2) modestly increased after surgery. Preoperative low LVSWI and high PVR were significant predictors for hospital mortality and LVAD implantation (p<0.0001, p=0.04, respectively) and early and mid-term MACE (p<0.02, p<0.02, respectively). Mean follow-up duration was 25±24 months. Three hospital deaths and 2 left ventricular assist device (LVAD) implantations occurred during hospitalization. Three-year freedom from MACE was 46.8%. NYHA functional class significantly improved (3.3±0.6 to 2.2±0.6, p<0.0001), LVESVI (158±40 to 134±39 ml/m2, p<0.001) and pulmonary vascular resistance (PVR) (213±137 to 149±79 dynes/s/cm5, p<0.04) significantly decreased, and LV stroke work index (LVSWI) (20.7±7.0 to 23.98±4.8 mmHg×mL/m2) modestly increased after surgery. Preoperative low LVSWI and high PVR were significant predictors for hospital mortality and LVAD implantation (p<0.0001, p=0.04, respectively) and early and mid-term MACE (p<0.02, p<0.02, respectively). ConclusionsMV surgery can improve early postoperative functional status and cardiac function in selected patients with advanced NIDCM. Preoperative LVSWI and PVR can be helpful to decide indication of MV surgery and predict postoperative clinical outcome. MV surgery can improve early postoperative functional status and cardiac function in selected patients with advanced NIDCM. Preoperative LVSWI and PVR can be helpful to decide indication of MV surgery and predict postoperative clinical outcome.