The Analysis Of The Left Ventricular End-diastolic Diameter Index And The Short-term Prognosis Of Mitral Valve Repair (MVP)

Objective To analyze the preoperative risk factors of the short-term prognosis of mitral valve repair(MVP).Methods Data of the patients who underwent MVP between January1,2011and December31,2012at Fu Wai Hospital were retrospectively reviewed, and the preoperative factors were analyzed.Results528patients were enrolled and493of whom (93.3%)were followed up with the mean age of50.07±13.23years, including329males(66.7%). Among those patients,103of whom were with atrial fibrillation(20.9%),364patients (73.8%) were dignosed for degenerative mitral regurgitation,77patients (15.6%) were for ischemic mitral regurgitation.preoperative EF62.03+9.2%,preoperative left ventricular end-diastolic diameter index (LVEDDI)31.6+5. Omm/m2;233cases(47.3%) were complicated by tricuspid regurgitation,190(38.5%)of whom underwent tricuspid annuloplasty. Previously51patients(10.3%) applied the forming rings, postoperative death happened to7people,7patients applied re-operation of mitral valve replacement or valvoplasty.45cases were identified moderate or severe mitral regurgitation by echocardiography after surgery. Statistical analysis demonstrated that preoperative risk factors are:combined atrial fibrillation (32.2%vs19.4%, p=0.023), combined tricuspid regurgitation (66.1%vs44.7%, p=0.002), lower EF (59.1±10.2vs62.4±9.0,p=0.009), larger left ventricular end-diastolic diameter index (33.5±5.1mm/m2vs31.4±5.0mm/m2, p=0.003),functional mitral regurgitation(20.3%vs13.1%,p=0.034). The multivariate cox analysis revealed that patients with greater changes in the left ventricular diameter after surgery (mainly decreasing) obtained significantly lower risk of postoperative endpoint events (adjusted risk ratio,0.015;95percent confidence interval,0.001to0.428P=0.014). The enlargement of the left ventricle is an independent preoperative risk factor (adjusted risk ratio,1.061;95percent confidence interval,1.002to1.124; P=0.042). For degenerative mitral regurgitation, Statistical analysis demonstrated that preoperative risk factors are:female (53.7%vs70.0%, p=0.035), combined atrial fibrillation (31.7%vs18.6%, p=0.048), combined tricuspid regurgitation (65.9%vs41.2%,p=0.003), lower EF (62.2±8.2%vs64.9±6.5%, p=0.019), larger left ventricular end-diastolic diameter index (33.4±4.4mm/m2vs31.8±4.3mm/m2, p=0.026),functional mitral regurgitation (12.2%vs1.9%,p=0.001). The multivariate cox analysis revealed that patients with greater changes in the left ventricular diameter after surgery (mainly decreasing) obtained significantly lower risk of postoperative endpoint events (adjusted risk ratio,0.008;95percent confidence interval,<0.001to0.726; P=0.036). The enlargement of the left ventricle is an independent preoperative risk factor (adjusted risk ratio,1.109;95percent confidence interval,1.031to1.192; P=0.005). as compared with patients with LVEDDI less than35mm/m2, those with preoperative LVEDDI more than35mm/m2had an increased risk of postoperative endpoint events (p=0.017).Conclusion Preoperative cardiac function impacts on the short-term prognosis of mitral valve repair. The enlargement of the left ventricle is an independent preoperative risk factor to affect the early prognosis of MVP. For degenerative mitral regurgitation, The patients with preoperative left ventricular end-diastolic diameter index more than35mm/m2may be not suitable for MVP.