Publication
Long-term follow-up of asymptomatic or mildly symptomatic patients with severe degenerative mitral regurgitation and preserved left ventricular function
dc.contributor.author | Coutinho, GF | |
dc.contributor.author | Garcia, AL | |
dc.contributor.author | Correia, PM | |
dc.contributor.author | Branco, C | |
dc.contributor.author | Antunes, MJ | |
dc.date.accessioned | 2017-01-05T11:35:07Z | |
dc.date.available | 2017-01-05T11:35:07Z | |
dc.date.issued | 2014-12 | |
dc.description.abstract | OBJECTIVES: The timing for mitral valve surgery in asymptomatic patients with severe mitral regurgitation and preserved left ventricular function remains controversial. We analyzed the immediate and long-term outcomes of these patients after surgery. METHODS: From January 1992 to December 2012, 382 consecutive patients with severe chronic degenerative mitral regurgitation, with no or mild symptoms, and preserved left ventricular function (ejection fraction ≥ 60%) were submitted to surgery and followed for up to 22 years (3209 patient-years). Patients with associated surgeries, other than tricuspid valve repair, were excluded. Cox proportional-hazard survival analysis was performed to determine predictors of late mortality and mitral reoperation. Subgroup analysis involved patients with atrial fibrillation or pulmonary hypertension. RESULTS: Mitral valvuloplasty was performed in 98.2% of cases. Thirty-day mortality was 0.8%. Overall survival at 5, 10, and 20 years was 96.3% ± 1.0%, 89.7% ± 2.0%, and 72.4% ± 5.8%, respectively, and similar to the expected age- and gender-adjusted general population. Patients with atrial fibrillation/pulmonary hypertension had a 2-fold risk of late mortality compared with the remaining patients (hazard ratio, 2.54; 95% confidence interval, 1.17-4.80; P = .018). Benefit was age-dependent only in younger patients (<65 years; P = .016). Patients with atrial fibrillation/pulmonary hypertension (hazard ratio, 4.20, confidence interval, 1.10-11.20; P = .037) and patients with chordal shortening were at increased risk for reoperation, whereas patients with P2 prolapse (hazard ratio, 0.06; confidence interval, 0.008-0.51; P = .037) and patients with myxomatous valves (hazard ratio, 0.072; confidence interval, 0.008-0.624; P = .017) were at decreased risk. CONCLUSIONS: Mitral valve repair can be achieved in the majority of patients with low mortality (<1%) and excellent long-term survival. Patients with atrial fibrillation/pulmonary hypertension had compromised long-term survival, particularly younger patients (aged <65 years), and are at increased risk of mitral reoperation. | pt_PT |
dc.description.version | info:eu-repo/semantics/publishedVersion | pt_PT |
dc.identifier.citation | J Thorac Cardiovasc Surg. 2014 Dec;148(6):2795-801. | pt_PT |
dc.identifier.doi | 10.1016/j.jtcvs.2014.06.089 | pt_PT |
dc.identifier.uri | http://hdl.handle.net/10400.4/2010 | |
dc.language.iso | eng | pt_PT |
dc.subject | Fibrilhação Auricular | pt_PT |
dc.subject | Procedimentos Cirúrgicos Cardíacos | pt_PT |
dc.subject | Valvuloplastia com Balão | pt_PT |
dc.subject | Insuficiência da Válvula Mitral | pt_PT |
dc.subject | Retrospective Studies | pt_PT |
dc.subject | Time Factors | pt_PT |
dc.title | Long-term follow-up of asymptomatic or mildly symptomatic patients with severe degenerative mitral regurgitation and preserved left ventricular function | pt_PT |
dc.type | journal article | |
dspace.entity.type | Publication | |
oaire.citation.endPage | 2801 | pt_PT |
oaire.citation.issue | 6 | pt_PT |
oaire.citation.startPage | 2795-801 | pt_PT |
oaire.citation.volume | 148 | pt_PT |
rcaap.rights | openAccess | pt_PT |
rcaap.type | article | pt_PT |