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

Abstract

Mitral regurgitation is a significant complication of end-stage cardiomyopathy, and its existence predicts poor survival. In general, it is thought that 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 ventricular end-systolic volume index was more than 100ml/m2 were studied. Although their prognosis late after MVR became poor, none of them died within 30 days of the operation. Postoperative cardiac catheterization was performed 6.3 ± 1.1 months after surgery; the end-diastolic volume had reduced (before: 193 ± 26 ml/m2; after: 166 ± 34 ml/m2, p<0.05), but the end-systolic volume had not (before: 110 ± 7 ml/m2; after: 112 ± 32ml/m2). The end-systolic wall stress was substantially elevated preoperatively (238 ± 29kdyne/cm2) and tended to increase after surgery (295 ± 96kdyne/cm2). 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), but 3 of the 5 patients died suddenly of heart failure at 3.3 ± 1.6 years after surgery and the New York Heart Association functional class of the others worsened to III again. Mitral valve surgery, including MVR, can manage severe end-stage heart disease with mitral regurgitation.