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Surgery for Acute Decompensated MItral Valve Disease: single centre experience of 292 patients
Sergey A. Leontyev, Piroze Davierwala, Martin Schneefogt, Farhad Bakhitiary, David Holzhey, Michael A. Borger, Martin Misfeld, Friedrich W. Mohr.
Heart Center, University of Leipzig, Leipzig, Germany.

Objective Urgent and emergent mitral valve (MV) surgery performed for acute decompensated MV disease is usually associated with an increased risk. We analyzed our early and late results, and determined the independent predictors of early and late mortality. Methods From 04/95 until 06/10 292 patients underwent MV surgery for acute decompensated MV disease, which was defined as patients presenting with dyspnea or tachycardia with pulmonary congestion or edema, and/or cardiogenic shock. Patient age was 64±11 years; 47.6% were female. Twenty percent of patients were in cardiogenic shock, 27% required inotropic support and 12% were intubated at the time of surgery. Acute endocarditis was the primary indication for surgery in 61% of patients. Mean follow-up was 6.1 ± 0.4 years (range 0 - 14 years) for all patients. Results Overall 30-day mortality was 20.2%. NYHA class IV (OR2.1, p=0.02, 95%CI1.1-4.2) and cardiogenic shock (OR5.1, p<0.01, 95%CI2.0-12.5) were identified as independent predictors of 30-day mortality. Cardiogenic shock (OR2.9, p<0.01, 95%CI1.6-5.1), preoperative inotropic support (OR1.9, p<0.01, 95%CI1.1-3.3), preoperative dialysis (OR2.5, p=0.02, 95% CI1.1-1.4), diabetes mellitus (OR1.7, p=0.04, 95%CI1.02-2.9) and preoperative NYHA class IV (OR1.2, p=0.01, 95%CI1.04-1.3) were independent predictors of long-term mortality. Mean survival at 1, 5 and 10 years was 61±3%, 52±3% and 28±5%, respectively. Conclusions Surgery for decompensated MV disease is associated with high early and long-term mortality, especially in patients with cardiogenic shock and advanced congestive heart failure. Efforts should be made to refer patients for MV surgery before the onset of advanced symptoms or congestive heart failure.

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