Morbidity and mortality in mitral valve surgery.

ABSTRACT

To develop strategies for the management of high-risk patients, contemporary risk factors for operative mortality and postoperative ventricular dysfunction were identified in 214 patients undergoing mitral valve surgery in 1982 and 1983. Thirty-eight preoperative and perioperative variables were prospectively collected and analyzed by univariate and multivariate statistics. The overall mortality was 4.6% and the incidence of postoperative low-output syndrome (LOS) was 18.7%. Forty-seven patients with coronary artery disease (CAD) had a higher mortality and incidence of LOS (as evidenced by the need for inotropic drugs or counterpulsation to maintain blood pressure) (those with CAD 15% mortality, 40% LOS; those without CAD 2% mortality, 13% LOS; p less than .05). The presence of unstable angina and ischemic mitral regurgitation further increased the risk. Age was also a predictor of outcome. Patients who died or had LOS were older (those who died, 65 +/- 7 years, those with LOS, 58 +/- 11 years) than patients who survived and did not have postoperative dysfunction (those who survived, 53 +/- 11; those with no LOS, 53 +/- 11; p less than .01). Mitral regurgitation was associated with a higher (p less than .05) mortality and incidence of LOS (mortality 10.5%, LOS 36%; n = 76) than was mitral stenosis (mortality 0%, LOS 4%; n = 74) or mixed lesions (mortality 3%, LOS 15%; n = 64). In patients without CAD, mitral regurgitation remained a significant predictor of mortality and ventricular dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)