Objective The studys objective was to examine factors associated with persis tent or recurrent congestive heart failure after mitral valve replacement. Metho ds Patients who underwent mitral valve replacement with contemporary prostheses (N=708) were followed with annual clinical assessment and echocardiography. Cox proportional hazardmodels were developed to evaluate the impact of demographic, comorbid, and valve-related variables on the occurrence of congestive heart fai lure after mitral valve replacement, defined as the composite outcome of New Yor k Heart Association class III or IV symptoms or death caused by congestive heart failure postoperatively. Factors associated with all-cause mortality were also examined. Models were bootstrapped 1000 times. Results The total follow-up was 3376 patient-years (mean 4.8±3.7 years, range 60 days to 17.1 years). Freedom from New York Heart Association III or IV symptoms or death caused by congestiv e heart failure was 96.1%±0.8%, 82.7%±1.7%, 66.4%±3.0%, and 38.8%±6.9 %at 1, 5, 10, and 15 years, respectively. Preoperative New York Heart Associati on class, left ventricular grade, atrial fibrillation, coronary artery disease, smoking, persistent tricuspid regurgitation, and redo status predicted congestiv e heart failure postoperatively (all P < .05). Patients who underwent mitral val ve replacement for pure mitral stenosis had less congestive heart failure events after surgery than those with regurgitation or mixed disease. Prosthesis size a nd elevated transprosthesis gradients were not predictive of freedom from conges tive heart failure after mitral valve replacement. Atrial fibrillation, persiste nt tricuspid regurgitation, and surgical referral for mitral valve replacement a t an advanced functional stage were also risk factors for all-cause mortality. Conclusions This study identifies the incidence of and risk factors for congesti ve heart failure and death late after mitral valve replacement. Although prosthe sis size has no effect,other potentially modifiable factors such as atrial fibri llation, persistent tricuspid regurgitation, and late surgical referral have a n egative impact on freedom from congestive heart failure and overall survival aft er mitral valve replacement.
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