Prediction of late survival in patients with mitral valve disease from clinical, hemodynamic, and quantitative angiographic variables.

Abstract

Late follow-up (average = 7.2 years) has been obtained in 249 patients with mitral valve disease who had quantitative angiographic assessment of left ventricular function at thetime of initial catheterization in the 1960s. Surgically treated patients with mitral valve disease had significantly improved survival as compared to medically treated patients with mitral disease. The subgroup with mixed mitral stenosis and regurgitation and the subgroup with moderate impairment of ejection fraction account for this improved survival in surgically treated patients, which occurred despite greater functional and hemodynamic impairment in the surgical cohorts. Using univariate life table survival analysis, ten variables were found to be predictive of survival in the medical cohort, and three in the surgical cohort. With multivariate Cox's regression analysis, end-diastolic volume and arteriovenous oxygen difference were significantly predictive of survival in the medical cohort; age was predictive of survival in the surgical cohort.

Echocardiographic prediction of survival after surgical correction of organic mitral regurgitation.

“…In patients with an ejection fraction <50%, the late mortality is high, but operation should not be contraindicated and has been shown to improve survival. 35 The use of echocardiographic left ventricular measurements may be a concern. However, two-dimensional echocardiography was used to direct all the measurements.…”

Surgical Correction of Mitral Regurgitation in the Elderly: Outcomes and Recent Improvements

“…Entry in multivariate analyses required values of PϽ0. 15, and values of PϽ0.05 were considered significant.…”

“…15,16 Furthermore, in judging whether a pessimistic appraisal of mitral surgery in the elderly is adequate, the natural age-mortality link has not been accounted for, so long-term survival relative to life expectancy in each age strata after surgery cannot be appreciated.…”

Primary mitral valve regurgitation: Update and review

“…43,44 That variation may be explained by poorly defined severity of mitral regurgitation, various selection biases and small study populations. [43][44][45][46][47][48] A series from Ling et al examined 229 patients with mitral regurgitation due to flail leaflet, many of who were symptomatic, had atrial fibrillation or evidence of left ventricular dysfunction. 49 Patients who were treated medically had a mortality rate significantly higher than the expected (6.3% yearly mortality, p = 0.016, when compared with the expected rate in the US population according to the 1990 census).…”