Left ventricular ejection fraction decline shortly after mitral valve operation and associated survival.
- 1Division of Cardiac Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY.
- 2Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
- 3Columbia Surgery Cardiovascular Research Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
Abstract
Objective
Reduction in left ventricular ejection fraction (LVEF) is common after mitral valve (MV) repair or replacement in patients with mitral regurgitation (MR). This study aims to evaluate the trajectory of postoperative LVEF reduction after MV surgery and determine whether this change in LVEF is associated with clinical outcomes.Methods
This is a retrospective study of 625 patients who underwent MV surgery for moderate/severe MR between 2015 and 2023. Patients with aortic valve pathology, concomitant aortic procedures, endocarditis, and previous MV operations were excluded. Patients were divided into 4 quartiles on the basis of pre- and postoperative percent difference in LVEF. In-hospital outcomes and long-term mortality using Kaplan-Meier analysis were compared between groups. Cubic spline adjusted for preoperative LVEF was used to determine the impact of percent LVEF difference on mortality. Spaghetti plots depicted the trajectory in LVEF over a 2-year follow-up period.Results
Patients were divided into percent LVEF reduction quartiles as follows: severely reduced (159 [25.4%], greater than -19%), moderately reduced (157 [25.1%], between -19% and -8%), stable (171 [27.4%], between -7% and +4%), and increased (138 [22.1%], greater than a +4%). Baseline characteristics were similar. There was no difference in the percent of patients undergoing MV repair versus replacement across LVEF reduction groups (P = .55). Postoperative outcomes were similar between groups, including reoperation for bleeding, stroke, and atrial fibrillation. Long-term survival probability over 7 years was similar between all 4 groups (P = .35). There was no significant change in hazards ratio for long-term mortality across range of LVEF differences. Patients with severely or moderately reduced LVEF postoperatively remained with a depressed LVEF during the 2-year follow-up period, whereas patients with the same or increased postoperative LVEF returned to baseline.Conclusions
Reduction in LVEF is common after MV repair or replacement with effects persisting after 2 years. Changes in LVEF after MV operation do not appear to affect clinical outcomes and may by itself not accurately reflect myocardial dysfunction related to MR and subsequent intervention.
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BibTeX
@article{rajesh2026left,
title = {{Left ventricular ejection fraction decline shortly after mitral valve operation and associated survival.}},
author = {Kavya Rajesh and Megan Chung and Luis Gisli Rabelo and James Lao and Julia Kim and Marco Tagliafierro and Berk Inan and Ian Mason and Nathan Ott and Vivian Zhang and William Mitchell and Isaac George and Makoto Mori and Arnar Geirsson},
journal = {JTCVS open},
year = {2026},
month = jul,
doi = {10.1016/j.xjon.2026.101962},
url = {https://europepmc.org/article/MED/42948156},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Left ventricular ejection fraction decline shortly after mitral valve operation and associated survival.
AU - Kavya Rajesh
AU - Megan Chung
AU - Luis Gisli Rabelo
AU - James Lao
AU - Julia Kim
AU - Marco Tagliafierro
AU - Berk Inan
AU - Ian Mason
AU - Nathan Ott
AU - Vivian Zhang
AU - William Mitchell
AU - Isaac George
AU - Makoto Mori
AU - Arnar Geirsson
PY - 2026
DA - 2026/07/16
JO - JTCVS open
DO - 10.1016/j.xjon.2026.101962
UR - https://europepmc.org/article/MED/42948156
AB - Objective Reduction in left ventricular ejection fraction (LVEF) is common after mitral valve (MV) repair or replacement in patients with mitral regurgitation (MR). This study aims to evaluate the trajectory of postoperative LVEF reduction after MV surgery and determine whether this change in LVEF is associated with clinical outcomes.Methods This is a retrospective study of 625 patients who underwent MV surgery for moderate/severe MR between 2015 and 2023. Patients with aortic valve pathology, concomitant aortic procedures, endocarditis, and previous MV operations were excluded. Patients were divided into 4 quartiles on the basis of pre- and postoperative percent difference in LVEF. In-hospital outcomes and long-term mortality using Kaplan-Meier analysis were compared between groups. Cubic spline adjusted for preoperative LVEF was used to determine the impact of percent LVEF difference on mortality. Spaghetti plots depicted the trajectory in LVEF over a 2-year follow-up period.Results Patients were divided into percent LVEF reduction quartiles as follows: severely reduced (159 [25.4%], greater than -19%), moderately reduced (157 [25.1%], between -19% and -8%), stable (171 [27.4%], between -7% and +4%), and increased (138 [22.1%], greater than a +4%). Baseline characteristics were similar. There was no difference in the percent of patients undergoing MV repair versus replacement across LVEF reduction groups (P = .55). Postoperative outcomes were similar between groups, including reoperation for bleeding, stroke, and atrial fibrillation. Long-term survival probability over 7 years was similar between all 4 groups (P = .35). There was no significant change in hazards ratio for long-term mortality across range of LVEF differences. Patients with severely or moderately reduced LVEF postoperatively remained with a depressed LVEF during the 2-year follow-up period, whereas patients with the same or increased postoperative LVEF returned to baseline.Conclusions Reduction in LVEF is common after MV repair or replacement with effects persisting after 2 years. Changes in LVEF after MV operation do not appear to affect clinical outcomes and may by itself not accurately reflect myocardial dysfunction related to MR and subsequent intervention.
SN - 2666-2736
ER -