Valve repair improves the outcome of surgery for XXXX . A multivariate analysis.

@entity1 @entity67 @entity339 @entity955
BACKGROUND: Mitral valve repair has been suggested as providing a better postoperative outcome than valve replacement for @entity339 , but this impression has been obscured by differences in baseline characteristics and has not been confirmed in multivariate analyses. METHODS AND RESULTS: The outcomes in 195 @entity1 with valve repair and 214 with replacement for organic @entity339 were compared using multivariate analysis. All @entity1 had preoperative echocardiographic assessment of left ventricular function. Before surgery, @entity1 with valve repair were less symptomatic than those with replacement (42% in New York Heart Association functional class I or II versus 24%, respectively; P = .001), had less @entity955 (41% versus 53%; P = .017), and had a better ejection fraction (63 +/- 9% versus 60 +/- 12%, P = .016). After valve repair, compared with valve replacement, overall survival at 10 years was 68 +/- 6% versus 52 +/- 4% (P = .0004), overall operative mortality was 2.6% versus 10.3% (P = .002), operative mortality in @entity1 under age 75 was 1.3% versus 5.7% (P = .036), and late survival (in operative survivors) at 10 years was 69 +/- 6% versus 58 +/- 5% (P = .018). Late survival after valve repair was not different from expected survival. After surgery, ejection fraction decreased significantly in both groups but was higher after valve repair (P = .001). Multivariate analysis indicated an independent beneficial effect of valve repair on overall survival (hazard ratio, 0.39; P = .00001), operative mortality (odds ratio, 0.27; P = .026), late survival (hazard ratio, 0.44; P = .001), and postoperative ejection fraction (P = .001). CONCLUSIONS: Valve repair significantly improves postoperative outcome in @entity1 with @entity339 and should be the preferred mode of surgical correction. The low operative mortality is an incentive for early surgery before @entity67 occurs.
