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Predictors of hospital mortality after surgery for ischemic mitral regurgitation
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  • Abdelsalam Elhenawy,
  • Khaled Algarni,
  • Vivek Rao,
  • Terrence Yau
Abdelsalam Elhenawy
University Health Network
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Khaled Algarni
University Health Network
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Vivek Rao
University Health Network
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Terrence Yau
University Health Network
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Abstract

BACKGROUND: The benefit of mitral valve repair over replacement in patients with ischemic mitral regurgitation is still controversial. We report our early postoperative outcomes of repair versus replacement. METHODS: Data were collected for patients undergoing first-time mitral valve surgery for ischemic mitral regurgitation between 1990 and 2009 (n = 393). Patients who underwent combined procedures for papillary muscle rupture, post-infarction ventricular septal defect, endocarditis, or any previous cardiac surgery were excluded. Preoperative demographics, operative variables, and hospital outcomes were analyzed, and multivariable regression analysis was employed to identify independent predictors of hospital mortality. RESULTS: Valve repair was performed in 42% (n=164) of patients and replacement in 58% (n=229). Patients who underwent replacement were older and had a higher prevalence of unstable angina, New York Heart Association class IV symptoms, preoperative cardiogenic shock, preoperative myocardial infarction, peripheral vascular disease, renal failure, and urgent or emergency surgery (all p < 0.05). Unadjusted hospital mortality was higher in patients undergoing valve replacement (13% versus 5%, p = 0.01). Valve repair was associated with a lower prevalence of postoperative low cardiac output syndrome. Multivariable analysis revealed that age, urgency of operation, and preoperative left ventricular function were independent predictors of hospital mortality. Importantly, mitral valve repair versus replacement was not an independent predictor of hospital mortality. CONCLUSION: Our data did not suggest an early survival benefit to mitral valve repair over replacement for ischemic mitral regurgitation. However, age, left ventricular dysfunction, and the need for urgent surgery were independently associated with hospital mortality.

Peer review status:ACCEPTED

29 Jul 2020Submitted to Journal of Cardiac Surgery
30 Jul 2020Submission Checks Completed
30 Jul 2020Assigned to Editor
30 Jul 2020Reviewer(s) Assigned
18 Aug 2020Review(s) Completed, Editorial Evaluation Pending
18 Aug 2020Editorial Decision: Revise Minor
09 Sep 20201st Revision Received
11 Sep 2020Submission Checks Completed
11 Sep 2020Assigned to Editor
11 Sep 2020Reviewer(s) Assigned
11 Sep 2020Review(s) Completed, Editorial Evaluation Pending
11 Sep 2020Editorial Decision: Accept