What Influences Early Left Ventricular Functional Changes after Mitral Valve Surgery with and without Concomitant Coronary Revascularization?

Background: Left ventricular ejection fraction (LVEF) typically remains unchanged after mitral valve surgery in the majority of patients. It sometimes, however, changes considerably in a proportion of patients. We investigated the influencing factors of this phenomenon and the respective 1-year outcomes.

Method: The patients who showed an immediate postoperative LVEF change of ≥5% were included in the study. All patients without a final postoperative echo before discharge or death (or without postoperative LVEF changes) were excluded from the study. Out of 1.666 patients, we observed deterioration of postoperative LVEF (DETER) in 250 patients and improvement (IMPROV) in 305 (LVEF: 56.8–39.8% vs. 43.4–54.3%, respectively). Baseline, risk profile, comorbidities, concomitant surgical procedures, laboratory, and echocardiographic data as well as postoperative course were obtained. Changes in LVEF and 1-year mortality were collected during outpatient follow-up contact. Statistical analysis was performed using ‘R’.

Results: DETER patients as compared with IMPROV patients showed significantly higher NT-pro-BNP preoperatively (5,011.8 vs. 3,530.4; p = 0.004), lower TAPSE (18. 8 vs. 20.3 mm, p = 0.003), higher pulmonary artery pressure (41.1 vs. 38.4 mm Hg, p = 0.03), higher proportion of pulmonary hypertension (26.1 vs. 11.4%, p < 0.001), and higher proportion of diastolic dysfunction (51.2 vs. 19.7%, p < 0.001). IMPROV patients frequently suffered preoperatively from secondary mitral regurgitation (sMR) (15.8 vs. 7.38%, p = 0.025) and more often had a concomitant coronary bypass procedure (26.9 vs. 19.2%, p = 0.043). LVEF gradually improved in the DETER patients (39.8–46.8%) and even improved slightly further in the IMPROV patients after one year. The trend, however, was more pronounced in the DETER patients.

Conclusion: A high preoperative NT-pro-BNP value and concomitant pulmonary hypertension negatively influence the outcome. Surprisingly, improvement in pump function after surgery was observed more frequently in patients with secondary mitral regurgitation due to coronary artery disease, although they are generally considered to have a lower potential for functional myocardial restoration than patients with primary regurgitation. Patients with initial functional loss did not entirely regain it after one year while patients with initial improvement could preserve this state.

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Artikel online veröffentlicht:
28. Januar 2023