Valve Surgery Outcomes

[potzie]

hi,
I am a 41 yr old male who has recently(3mths ago) been diagnosed with MVP with severe regurgitation(4/4). I have chronic AF with a controlled ventricular rate(low 50bpm resting). Prolapse is bileaflet with anterior directed jet. Not sure if anterior prolapse is primarily due to loss of coaptation with flail posterior leaflet.

LV(7.6cm/4.6cm) and LA(6.7cm)
RV and RA are moderately dilated
LVEDP 18-20, LVEDV 210ml
LVESV 63ml
LA Area 42cm2, RA Area 30cm2
EF 70%, FS 40%
RSVP 30mmHg
CO 4 l/min
BP 120/80
Mild pulmonary hypertension with normal coronary arteries

I am reasonably asymptomatic apart from the AF and reduced peak exercise performance. I do not have any issues sleeping, but do suffer from tiredness/fatigue.
I have a number of questions around surgical outcomes, but understand some things cannot be accurately answered without good knowledge of the valve pathology.

1. Am I a good candidate for valve repair instead of replacement given the degree of dilation?
2. Would some form of MAZE procedure be useful during the valve open heart surgery?
3. What chances do I have of returning to normal sinus rhythm post surgery if maze is also done?
4. Given the dilation present (annular dilation of mitral annulus not known), if the valve is repaired, what type of annulplasty ring would most likely be used and why? Rigid or flexible?
5. Is it still possible for the LV / LA to remodel after repair given the severe dilation?
6. What is the potential durability of repair given the severe dilation?
7. What will happen to the LV EF after the valve is repaired? Will this improve over time?
8. Given the above symptoms/findings, should I be limiting(currently cycling 150-200km/week) the amount of exercise I do prior to surgery?
9. Will exercise accelerate the remodeling process so the heart begins to decompensate sooner, or is the intensity of the exercise the critical factor?

Thank you for your time, sorry so many Q's

[potzie]

Hi,

Thanks for taking the time to answer my queries.
Re Q7, what I was referring to was the recovery of EF after surgery. It is well noted that EF will decline immediately after surgery. Is it likely to return to normal?

Thanks

[CCFCardio MD1]

You certainly have a lot of specific questions that would most certainly be best answered by your primary cardiologist as well as cardiothoracic surgeon.  However, I will try to address your concerns in the setting of a typical patient with severe mitral regurgitation and atrial fibrillation.
1. A repair is generally possible in most patients and at the Cleveland Clinic, the majority of patients undergo repair
2. A MAZE is usually done in patients with atrial fibrillation during mitral valve surgery.
3. The success of a MAZE procedure is fairly high (published reports of greater than 90%)
4. This decision is highly dependent on the anatomy and surgical preference.
5. Yes
6. After mitral valve repair, 95% of patients are free of reoperation at 10 years, and this statistic is similar at 20 years.
7. Based on the information provided, an EF (or ejection fraction) of 70% is considered normal.
8. If exercise is well tolerated, there is generally no need to limit it.
9. The remodeling process is dependent on many factors (age, hypertension).  Not much is published regarding the impact of exercise on the remodeling process.