Can restrictive left ventricular diastolic filling pattern predict the early and late outcome of ischemic mitral valve repair

Abstract

The aim of the study was to evaluate the influence of left ventricular (LV) diastolic filling (DF) impairment on early and late postoperative results in patients (pts) with low LV ejection fraction (EF<35%) and moderate to severe mitral valve (MV) incompetence undergoing combined surgery – CABG with MV repair. Materials and methods: The study included 63 pts with coronary artery disease and severe LV systolic dysfunction (mean EF – 26,1±6%), who were divided into three groups according to LV DF. The study protocol included evaluation of: 1)early postoperative mortality, 2) late (following 1 year) NYHA functional class changes, 3) late LV function and MV incompetence dynamics. A number of variables which might affect postoperative events were entered into a logistic regression model. Results: Early postoperative mortality rate was highest in restriction group -33,3% versus (vs) pseudonormal – 15,8% vs impaired relaxation – 7,7%. In the late postoperative period 78,6% of pts with preoperative restrictive DF remained in III-IV NYHA functional class vs 31,2% in pseudonormal and vs 16,7% in impaired relaxation group (p<0,001). LV end diastolic diameter index early and late after surgery had tendency to increase in restriction group and decreased in the remaining groups. LV end systolic diameter index late after surgery increased significantly in restriction group (from 26,7±4,6 mm/m2 to 29,5±3,7mm/m2, p<0,05), but decreased in the remaining groups. LV EF and wall motion score (WMS) did not change postoperatively in pts with restrictive DF (WMS improved only in 28% of the group pts)and significantly improved in the remaining groups (56,2% - pseudonormal and 50% - impaired relaxation DF). MV incompetence degree decreased significantly early after MV repair in all groups, but late postoperatively mild to moderate MV incompetence was noted in 85,7% of the pts in restriction group (vs 47,6% and 31,3% in the remaining groups, p<0,05). [...].