Tricuspid Valve Regurgitation is a Risk Factor for Worsening of Ejection Fraction after Minimally Invasive Surgery for Primary Mitral Valve Regurgitation
Yukiharu Sugimura, MD, Shintaro Katahira, MD, PhD, Moritz B. Immohr, MD, Philipp Rellecke, MD, Jan P. Minol, MD, Patrick Horn, MD, PhD, Ralf Westenfeld, MD,PhD, Hug Aubin, MD,PhD, Alexander Albert, MD,PhD, Artur Lichtenberg, MD,PhD, Payam Akhyari, MD,PhD.
Heinrich Heine University, Duesseldorf, Germany.
OBJECTIVE: According to the guidelines of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS), left ventricular ejection fraction (EF) of 30% to 60% is classified as class I indication for surgery in primary mitral valve regurgitation (MR). However, preoperative EF (PreEF) in MR may be overestimated and follow up EF (FuEF) occasionally deteriorates after surgery in spite of good PreEF. Here, we evaluate our data for risk factors of worsened FuEF in the setting of minimally invasive mitral valve surgery (MIMVS) for primary MR.METHODS: We reviewed the perioperative and 1-year follow-up data from 436 patients with primary MR (338 isolated MIMVS und 98 MIMVS combined with tricuspid valve repair) to investigate the correlation between PreEF and EF evolution, defined as FuEF-PreEF using Spearman's rank test. Also risk factors for decreased FuEF were analyzed in a multivariate analysis. Chi-Quadrat-Test, Odds Ratio (OR), and Unpaired t-test were used to compare the differences between subcohorts.RESULTS: A significant correlation was observed for PreEF und EF evolution that the higher PreEF, the more pronounced decreased EF evolution (in all 436 patients; r= -0.538, p<0.001, in isolated MIMVS; r= -0.541, p<0.001 (Figure 1.), in combined MIMVS; r= -0.528, p<0.001). Statistically significant differences for negative EF evolution were evident in the patients with tricuspid valve regurgitation (TR) (in all patients; p<0.05, OR=1.636, in isolated MIMVS; p<0.01, OR=1.931, respectively). Interestingly, this trend was strongest in patients with good PreEF. Other factors, e.g. coronary artery disease and its risk factors, preoperative cardiac index, pathology of mitral valve disease, method of operation (replacement or repair), and operation time, proved no predictive value with regards to negative EF evolution.CONCLUSIONS: TR could be a predictor of worsened FuEF in patients undergoing isolated MIMVS, especially when PreEF is preserved.
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