The impact of preoperative left ventricular ejection fraction on short and mid-term outcomes in ischaemic mitral valve repair

Abstract

Background: It has been well established that reduced left ventriclular ejection fraction (LVEF) has adverse impact on the outcome of patients undergoing ischaemic mitral valve repair. However, the exact value of LVEF which should be used for risk stratification, has not been well established.
Aim: To asses which preoperative LVEF (pLVEF) value has the best predictive value in patients undergoing ischaemic mitral valve repair.
Methods: A retrospective analysis of 105 patients with ischaemic mitral regurgitation (IMR) treated between January 2003 and June 2009 was conducted. Patients were divided into two groups according to their pLVEF value. The primary endpoints were early in-hospital and late follow-up deaths.
Results: The pLVEF cut-off value was determined based on univariate analysis of parameters for primary end-points. The investigated parameters were: age, pLVEF, postoperative NYHA, postoperative mitral regurgitation and postoperative LVEF. The Cox proportional hazard regression analysis identified pLVEF (HR 1.5; 95% CI 1.4-5.0; p < 0.008) as the only independent predictor of the primary end-point. The pLVEF cut-off value of 40% was found to have the highest sensitivity of 76% and specificity of 70% in predicting death. Patients were divided into two groups using the cut-off value of pLVEF of 40%. The compromised group (pLVEF < 40%) of 34 patients and the uncompromised group (pLVEF > 40%) of 71 patients had inhospital death rates of three (9%) vs two (3%) (NS) and five year mortality of 18 (54%), eight (11%) (p < 0.001), respectively.
Conclusions: In IMR surgery, a pLVEF value of 40% is an important prognostic marker for mid-term survival.
Kardiol Pol 2010; 68, 11: 1226-1232