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Long-term follow-up of asymptomatic or mildly symptomatic patients with severe degenerative mitral regurgitation and preserved left ventricular function

dc.contributor.authorCoutinho, GF
dc.contributor.authorGarcia, AL
dc.contributor.authorCorreia, PM
dc.contributor.authorBranco, C
dc.contributor.authorAntunes, MJ
dc.date.accessioned2017-01-05T11:35:07Z
dc.date.available2017-01-05T11:35:07Z
dc.date.issued2014-12
dc.description.abstractOBJECTIVES: 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.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJ Thorac Cardiovasc Surg. 2014 Dec;148(6):2795-801.pt_PT
dc.identifier.doi10.1016/j.jtcvs.2014.06.089pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.4/2010
dc.language.isoengpt_PT
dc.subjectFibrilhação Auricularpt_PT
dc.subjectProcedimentos Cirúrgicos Cardíacospt_PT
dc.subjectValvuloplastia com Balãopt_PT
dc.subjectInsuficiência da Válvula Mitralpt_PT
dc.subjectRetrospective Studiespt_PT
dc.subjectTime Factorspt_PT
dc.titleLong-term follow-up of asymptomatic or mildly symptomatic patients with severe degenerative mitral regurgitation and preserved left ventricular functionpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage2801pt_PT
oaire.citation.issue6pt_PT
oaire.citation.startPage2795-801pt_PT
oaire.citation.volume148pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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