Do Not Withhold Mitral Surgery from Patients with Poor Left Ventricular Function

Abstract

Background and Objectives: Increasing reluctance to perform surgical mitral valve repair or replacement particularly in high-risk patients with poor left-ventricular function is trending. These patients are increasingly treated interventionally, e.g., by MitraClip, but often show only low to moderate improvement. The primary objective of the study was to investigate whether left ventricular ejection fraction (LVEF) influences postoperative mortality. Materials and Methods: The study included 903 patients undergoing mitral valve repair or replacement between 2009 and 2021. Statistical comparison was performed between patients with LVEF ≤ 30% and LVEF > 30%. Finally, statistical analysis was performed according to propensity score matching (1:3 PS matching). Results: No significant difference in in-hospital mortality was found before and after matching regarding LVEF ≤ 30% and LVEF > 30% (Pre: 10.8% vs. 15.1%, p = 0.241, after: 11.6% vs. 18.1%, p = 0.142). After PS matching, the 112 patients with LVEF ≤ 30% compared with 336 patients with LVEF > 30% showed a significantly higher preoperative NT-proBNP (p < 0.001), larger diameters at preoperative left ventricle and atrium (p < 0.001), lower preoperative TAPSE (p = 0.003) and PAP (p = 0.003), and more dilated cardiomyopathy and chronic kidney disease (p < 0.001, p = 0.045). Conclusions: The results of this study demonstrate that poor preoperative LVEF alone does not play a significant role in postoperative outcome and long-term mortality. Prognosis appears to be multifactorial. Poor preoperative LVEF is not a contraindication for surgery and does not justify primary interventional treatment accepting inferior hemodynamic results impeding outcome.

Case of Dilated Cardiomyopathy in Combination with Left Atrial Myxoma and Left Atriomegaly (Rare Clinical Case)

“…Adequate plastic correction of functional mitral-tricuspid insufficiency, along with the elimination of myxoma and LA plasty, significantly improved the morphometry of the left heart and the contractility of LV already at the early hospital stage [4,6,9]. Elimination of giant LA myxoma, together with the maternal basement, is an important element of radicalism and the absence of relapse in the long term.…”

“…Left atriomegaly in the presence of a tachyform AF contributes to the formation of blood clots in the cavity of the LA and thromboembolic complications occurring in this case. Extreme dilated LA contributes to the progression of heart and respiratory failure due to compression of the bronchi, trachea and posterior wall of LV [1,5,6,7]. Therefore, we consider it necessary to carry out LA reduction.…”

“…Concomitant left atriomegaly leads to compression of LV, bronchi, resulting in signi icant respiratory disorders and heart failure. Dilation of left atrium (LA) is a factor that prevents the restoration of sinus rhythm and increases the risk of thromboembolic complications [2,5,6,7,8,9]. Joining of giant LA myxoma to this complex pathology further increases the risk of surgery [10,11,12,13,14].…”