Concomitant mitral valve surgery in patients undergoing surgical ventricular reconstruction for ischaemic cardiomyopathy
Bibliographic record
Abstract
OBJECTIVES: Ischaemic mitral valve regurgitation is associated with a significant reduction in survival and its treatment in patients undergoing surgical ventricular reconstruction is usually associated with higher perioperative morbidity and mortality. We evaluated our 11-year experience in this cohort of patients. METHODS: Between January 2000 and December 2010, a total of 282 patients underwent surgical ventricular reconstruction, of which 45 (16%) had concomitant mitral valve surgery. The data was retrospectively analyzed to identify variables that could predict early mortality. RESULTS: Overall in-hospital mortality was 6.4% (n = 18), of which 5.1% (n = 12) occurred in patients undergoing surgical ventricular reconstruction and 13.3% (n = 6) in patients undergoing surgical ventricular reconstruction + mitral valve surgery (P = 0.05). Patients undergoing surgical ventricular reconstruction + mitral valve surgery had poorer LV function (P < 0.01) and advanced NYHA class IV symptoms (P = 0.02) compared with patients undergoing surgical ventricular reconstruction. These patients had a higher requirement for postoperative inotropic (P < 0.01) and IABP support (P < 0.01) and were more likely to suffer from low cardiac output syndrome (P < 0.01). In patients undergoing surgical ventricular reconstruction + mitral valve surgery, 34 patients had mitral valve repair and 11 patients had mitral valve replacement. The mortality was 17.6% (n = 6) vs 0% (P = 0.31) in the mitral valve repair vs mitral valve replacement groups, respectively. The cohort of patients undergoing surgical ventricular reconstruction + mitral valve repair had poorer LV function and more advanced symptoms. CONCLUSIONS: Patients undergoing surgical ventricular reconstruction have excellent early outcomes. However, there are patients that are at an increased operative risk, such as those with concomitant ischaemic mitral regurgitation that might be better served with other surgical modalities, such as ventricular assist device or heart transplantation. The suggested algorithm based on current evidence provides a stepwise approach when dealing with patients with ischaemic mitral regurgitation ± left ventricular remodelling.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".