Impact of Preoperative Left Ventricular Dimensions on Early Outcomes After Mitral Valve Repair for Degenerative Mitral Regurgitation.

Abstract

Current guidelines include left ventricular end-systolic diameter (LVESD) as a threshold criterion for operative intervention in degenerative mitral regurgitation (DMR). We examined a contemporary mitral repair cohort to determine when LVESD served as the operative trigger and whether preoperative left ventricular end-diastolic diameter (LVEDD) was associated with early postoperative outcomes. We analyzed DMR patients who underwent mitral valve repair (2021-2024) at a single center. Left ventricular dimensions were obtained from echocardiographic reports at preoperative consultation, before discharge, and at postdischarge follow-up when available through the electronic medical record. Associations between preoperative dimensions and clinical outcomes were evaluated by multivariable logistic regression. Of 364 patients, 82% (n = 300) met class I criteria and 18% (n = 64) met class IIa criteria. Only 15% (n = 54) had LVESD ≥4 cm; 1.4% (n = 5) met class I indications based on LVESD. However, 35% (n = 126) met sex-specific LVEDD thresholds for ventricular enlargement (women: ≥5.3 cm; men: ≥5.9 cm). Preoperative LVEDD was independently associated with 30-day readmission (odds ratio, 3.19; 95% CI, 1.56-6.70; P = .0018) and new-onset sustained atrial fibrillation (odds ratio, 2.41; 95% CI, 1.03-5.73; P = .04), unlike LVESD. Of class IIa patients, 16 of 64 (25%) had elevated LVEDD with lower discharge LVEF and higher 30-day cardiac-related readmission. In this contemporary DMR cohort, preoperative LVESD rarely served as the sole operative trigger. LVEDD was more frequently elevated and independently associated with early adverse outcomes, supporting its role as a complementary marker of remodeling for further study.