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Eur J Cardiothorac Surg 2002;22:90-94
© 2002 Elsevier Science NL

Outcome following mitral valve replacement in patients with mitral stenosis and moderately reduced left ventricular ejection fraction

^a Department of Medicine (Cardiology Division), Massachusetts General Hospital, Boston, MA, USA
^b Department of Surgery (Cardiac Surgical Division), Harvard Medical School, Boston, MA, USA

Received 18 December 2001; received in revised form 27 March 2002; accepted 28 March 2002.

* Corresponding author. Cardiology Division, Massachusetts General Hospital, 15 Parkman Street, WACC Suite 478, Boston, MA 02114-3117, USA. Tel.: +1-617-726-1832; fax: +1-617-726-5988
e-mail: mfifer{at}partners.org

Background: Some patients with mitral stenosis (MS) have moderately reduced left ventricular (LV) ejection fraction (EF), due to either depressed myocardial contractility or alterations in loading conditions. The effect of moderately reduced LV EF on outcome after mitral valve replacement (MVR) is not known. Methods: We studied 16 consecutive patients with LV EF 0.50 and MS without significant mitral regurgitation or other valvular or coronary artery disease (Group I). We selected four controls with LV EF >0.50 for each patient, matched for time of surgery (Group II, n=64). Mean EF in Groups I and II was 0.45 and 0.66, respectively. We compared short- and long-term outcome between the two groups. Results: There were no perioperative deaths. Group I patients had a higher incidence of in-hospital postoperative heart failure (25% vs. 6%, P=0.02). Mean follow-up was 9 years in both groups. Mean New York Heart Association class improved from 2.4 to 1.7 in both groups. Group I patients had a higher incidence of heart failure deaths (13% vs. 2%, P=0.03) and admissions (40% vs. 13%, P=0.01). There were, however, no differences between Groups I and II in overall mortality (27% vs. 21%), rate of cardiac admissions (69% vs. 53%), or mean Specific Activity Scale Score (2.5 vs. 2.5). Conclusions: Although patients with MS and moderately reduced LV EF are at higher risk for heart failure after MVR, overall mortality is not different from that of patients with normal EF. Moderate depression of LV EF should not be a contraindication to MVR for MS.

Key Words: Mitral valve • Mitral stenosis • Mitral valve replacement • Clinical outcome • Congestive heart failure