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Predictors of hospital mortality after surgery for ischemic mitral regurgitation: the Toronto General Hospital experience.

Authors
  • Elhenawy, Abdelsalam M1, 2
  • Algarni, Khaled1, 3
  • Rao, Vivek1
  • Yau, Terrence M1
  • 1 Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada. , (Canada)
  • 2 Division of Cardiothoracic Surgery, Al Azhar University, Cairo, Egypt. , (Egypt)
  • 3 Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia. , (Saudi Arabia)
Type
Published Article
Journal
Journal of Cardiac Surgery
Publisher
Wiley (Blackwell Publishing)
Publication Date
Dec 01, 2020
Volume
35
Issue
12
Pages
3334–3339
Identifiers
DOI: 10.1111/jocs.15064
PMID: 32985733
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The benefit of mitral valve repair (MVr) over replacement in patients with severe ischemic mitral regurgitation (IMR) is still controversial. We report our early postoperative outcomes of repair versus replacement. Data were collected for patients undergoing first-time mitral valve surgery for severe IMR 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. 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 < .05). Unadjusted hospital mortality was higher in patients undergoing valve replacement (13% vs. 5%; p = .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 (LV) function were independent predictors of hospital mortality. Importantly, MVr versus replacement was not an independent predictor of hospital mortality. Our data did not suggest an early survival benefit to MVr over replacement for IMR. However, age, LV dysfunction, and the need for urgent surgery were independently associated with hospital mortality. © 2020 Wiley Periodicals LLC.

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