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| Does Earlier Surgery Improve Left Ventricular Mass Regression Following Mitral Valve Repair for Leaflet Prolapse? |
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John M. Stulak, Rakesh M. Suri, Joseph A. Dearani, Harold M. Burkhart, Thoralf Sundt, Maurice Sarano, Hartzell V. Schaff; Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, MN Objective: Left ventricular hypertrophy in valvular heart disease is associated with poor long-term survival. Although reverse remodeling of left ventricular dimensions has been shown occur following mitral valve repair, it is unclear whether significant mass regression follows, and if so, which factors predict improved long-term normalization of left ventricular hypertrophy. Methods: Between March 1995 to December 2005, 2,584 patients had mitral valve repair. Of these, 463 pt (324 male) underwent repair for leaflet prolapse and had echocardiographic data available from which left ventricular mass index (LVMI) could be calculated. Concomitant preoperative tricuspid valve regurgitation (TR) was more than mild in 81 pt (17%). Patients with preoperative atrial fibrillation and other cardiac pathology necessitating concomitant intracardiac repair were not included. Results: Significant regression of LVMI occurred during the first 3 years (-28 g/m2 from baseline, P<0.001) and was maintained during follow-up longer than 3 years (-26 g/m2 from baseline, P<0.001) (Figure 1). In a multivariable model, higher preoperative left ventricular ejection fraction and greater preoperative LVMI were associated with significantly greater LVMI regression at 3 years. During follow-up later than 3 years, greater preoperative LVMI persisted in predicting improved mass regression (P<0.001), while more than mild preoperative tricuspid valve regurgitation was independently associated with less late mass regression (p<0.001). Conclusion: Performing mitral valve repair before a fall in preoperative left ventricular ejection fraction and the development of significant TR predicts a greater likelihood of significant regression of left ventricular hypertrophy. These data provide additional support for early valve repair in patients with degenerative mitral valve disease. 
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