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Mitral Valve Annuloplasty Does Not Reduce Mortality in Patients with Mitral Regurgitation and Left Ventricular Systolic Dysfunction

February 9, 2005

By Ashley Starkweather, B.S. and Asher Kimchi M.D.

Ann Arbor, MI - In a retrospective study of 419 patients between 1995 and 2002, mitral valve annuloplasty (MVA) was shown to have no effect on the mortality outcome of patients with mitral regurgitation and left ventricular systolic dysfunction. The study, published by Audrey H. Wu, M.D., M.P.H., et. al., from the Division of Cardiology at the University of Michigan in the February 1, 2005 issue of the Journal of the American College of Cardiology, was designed to determine the effect of MVA on long-term mortality in this sub-group of patients. While increased risk of mortality was associated with coronary artery disease, increased BUN, cancer, and digoxin, decreased risk of mortality was linked to ACE inhibitors, beta-blockers, low mean arterial pressure and decreased serum sodium. MVA did not predict clinical outcome. 

In this patient population, mitral valve annuloplasty has been shown to improve hemodynamics and symptoms, but its effect on long term mortality is not clear. In order to assess the relationship between risk of mortality and MVA in these patients, the investigators retrospectively identified 682 consecutive patients who had significant mitral regurgitation and left ventricle systolic dysfunction on echocardiography between 1995 and 2002. Of these patients, 419 were identified as surgical candidates, and 126 actually underwent MVA. The primary endpoint of the study was patient mortality. 

The primary endpoint was reached by 120 (41%) of the patients in the non-MVA group, and by 62 (49%) of the patients who underwent MVA. Increased risk of mortality was associated with coronary artery disease, increased BUN, cancer, and digoxin. Decreased risk of mortality was linked to ACE inhibitors, beta-blockers, low mean arterial pressure and decreased serum sodium. MVA did not have any significant association to mortality and therefore was not useful as a clinical predictor of outcome. 

In this study, there is no significant mortality benefit conferred by MVA for significant mitral regurgitation with severe left ventricle dysfunction. The authors suggest that a prospective randomized control trial is warranted to further investigate the association between mortality and MVA in this patient population. 

Co-authors: Keith D. Aaronson, M.D., M.S.; Steven F. Bolling, M.D., F.A.C.C.; Francis D. Pagani, M.D., Ph.D., F.A.C.C.; Kathy Welsh, M.S., M.P.H.; Todd M. Koelling, M.D., F.A.C.C. 


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