{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T04:43:48Z","timestamp":1760244228221,"version":"build-2065373602"},"reference-count":14,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,9,5]],"date-time":"2022-09-05T00:00:00Z","timestamp":1662336000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Increasing reluctance to perform surgical mitral valve repair or replacement particularly in high-risk patients with poor left-ventricular function is trending. These patients are increasingly treated interventionally, e.g., by MitraClip, but often show only low to moderate improvement. The primary objective of the study was to investigate whether left ventricular ejection fraction (LVEF) influences postoperative mortality. Materials and Methods: The study included 903 patients undergoing mitral valve repair or replacement between 2009 and 2021. Statistical comparison was performed between patients with LVEF \u2264 30% and LVEF &gt; 30%. Finally, statistical analysis was performed according to propensity score matching (1:3 PS matching). Results: No significant difference in in-hospital mortality was found before and after matching regarding LVEF \u2264 30% and LVEF &gt; 30% (Pre: 10.8% vs. 15.1%, p = 0.241, after: 11.6% vs. 18.1%, p = 0.142). After PS matching, the 112 patients with LVEF \u2264 30% compared with 336 patients with LVEF &gt; 30% showed a significantly higher preoperative NT-proBNP (p &lt; 0.001), larger diameters at preoperative left ventricle and atrium (p &lt; 0.001), lower preoperative TAPSE (p = 0.003) and PAP (p = 0.003), and more dilated cardiomyopathy and chronic kidney disease (p &lt; 0.001, p = 0.045). Conclusions: The results of this study demonstrate that poor preoperative LVEF alone does not play a significant role in postoperative outcome and long-term mortality. Prognosis appears to be multifactorial. Poor preoperative LVEF is not a contraindication for surgery and does not justify primary interventional treatment accepting inferior hemodynamic results impeding outcome.<\/jats:p>","DOI":"10.3390\/medicina58091220","type":"journal-article","created":{"date-parts":[[2022,9,6]],"date-time":"2022-09-06T22:33:01Z","timestamp":1662503581000},"page":"1220","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Do Not Withhold Mitral Surgery from Patients with Poor Left Ventricular Function"],"prefix":"10.3390","volume":"58","author":[{"given":"Roya","family":"Ostovar","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg, Faculty of Health Sciences Brandenburg, Medical School Theodor Fontane, 16321 Bernau, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Max","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg, Faculty of Health Sciences Brandenburg, Medical School Theodor Fontane, 16321 Bernau, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filip","family":"Schroeter","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg, Faculty of Health Sciences Brandenburg, Medical School Theodor Fontane, 16321 Bernau, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralf-Uwe","family":"Kuehnel","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg, Faculty of Health Sciences Brandenburg, Medical School Theodor Fontane, 16321 Bernau, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline","family":"Rashvand","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg, Faculty of Health Sciences Brandenburg, Medical School Theodor Fontane, 16321 Bernau, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1889-6039","authenticated-orcid":false,"given":"Martin","family":"Hartrumpf","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg, Faculty of Health Sciences Brandenburg, Medical School Theodor Fontane, 16321 Bernau, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes Maximilian","family":"Albes","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg, Faculty of Health Sciences Brandenburg, Medical School Theodor Fontane, 16321 Bernau, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/S0140-6736(06)69208-8","article-title":"Burden of valvular heart diseases: A population-based study","volume":"368","author":"Nkomo","year":"2006","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.amjcard.2015.10.044","article-title":"Comparison of Percutaneous Mitral Valve Repair Versus Conservative Treatment in Severe Functional Mitral Regurgitation","volume":"117","author":"Giannini","year":"2016","journal-title":"Am. J. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/j.jcmg.2018.01.009","article-title":"Mitral Valve Regurgitation in the Contemporary Era","volume":"11","author":"Reddy","year":"2018","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1002\/ehf2.12287","article-title":"Mitral valve interventions in heart failure","volume":"5","author":"Lavall","year":"2018","journal-title":"ESC Heart Fail."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1093\/eurheartj\/ehv680","article-title":"Left ventricular systolic function assessment in secondary mitral regurgitation: Left ventricular ejection fraction vs. speckle tracking global longitudinal strain","volume":"37","author":"Kamperidis","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1186\/s13019-020-01309-6","article-title":"Mitral valve repair for degenerative mitral regurgitation in patients with left ventricular systolic dysfunction: Early and mid-term outcomes","volume":"15","author":"Li","year":"2020","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1002\/ehf2.12741","article-title":"Outcome comparison of mitral valve surgery and MitraClip therapy in patients with severely reduced left ventricular dysfunction","volume":"7","author":"Gyoten","year":"2020","journal-title":"ESC Heart Fail."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"326","DOI":"10.5761\/atcs.oa.19-00093","article-title":"Isolated Mitral Valve Repair in Patients with Reduced Left Ventricular Ejection Fraction","volume":"25","author":"Noack","year":"2019","journal-title":"Ann. Thorac. Cardiovasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.jjcc.2017.09.013","article-title":"Feasibility and limitations of mitral valve repair, with or without left ventricular reconstruction in non-ischemic dilated cardiomyopathy","volume":"71","author":"Shingu","year":"2018","journal-title":"J. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"183","DOI":"10.21470\/1678-9741-2019-0440","article-title":"Morbidity and Mortality in Patients Undergoing Mitral Valve Replacement at a Cardiovascular Surgery Referral Service: A Retrospective Analysis","volume":"36","author":"Moreira","year":"2021","journal-title":"Braz. J. Cardiovasc. Surg."},{"key":"ref_11","unstructured":"(2022, August 12). Herzchirurgische Daten und Fakten in der DGTHG-Leistungsstatistik Publiziert. Available online: https:\/\/www.dgthg.de\/de\/dgthg_leistungsstatistik."},{"key":"ref_12","unstructured":"R Core Team (2020). R: A Language and Environment for Statistical Computing, Foundation for Statistical Computing."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/j.jacc.2009.08.074","article-title":"Increased Oxidative Stress and Cardiomyocyte Myofibrillar Degeneration in Patients With Chronic Isolated Mitral Regurgitation and Ejection Fraction > 60%","volume":"55","author":"Ahmed","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1093\/ejechocard\/jeq031","article-title":"European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: Mitral and tricuspid regurgitation (native valve disease)","volume":"11","author":"Lancellotti","year":"2010","journal-title":"Eur. J. Echocardiogr."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/9\/1220\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:23:23Z","timestamp":1760142203000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/9\/1220"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,5]]},"references-count":14,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["medicina58091220"],"URL":"https:\/\/doi.org\/10.3390\/medicina58091220","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2022,9,5]]}}}