Dynamics of left ventricular ejection fraction changes after surgical correction of mitral regurgitation
DOI:
https://doi.org/10.11603/ijmmr.2413-6077.2026.1.16460Keywords:
reverse remodelling, echocardiography, systolic function, annuloplasty, valve replacement, postoperative recovery, myocardial contractilityAbstract
Abstract. Mitral regurgitation is among the most prevalent disorders of the cardiac valvular apparatus and leads to chronic volume overload, left ventricular dilatation, and adverse ventricular remodelling. Despite the proven efficacy of contemporary surgical techniques for correcting mitral regurgitation, early recovery of left ventricular systolic function and the tempo of reverse remodelling remain clinically important. The aim of this study was to assess early postoperative changes in left ventricular systolic function and to analyse the dynamics of ejection fraction as a marker of the effectiveness of surgical correction of mitral regurgitation. The study enrolled 40 patients with grade III-IV mitral regurgitation who underwent either mitral valve repair (45%) or mitral valve replacement (55%). Transthoracic echocardiography was performed three times – preoperatively and at 1 and 3 months after surgery. Ejection fraction was calculated using the biplane Simpson method in accordance with ASE/EACVI recommendations. Statistical analysis was performed using built-in Microsoft Excel tools with computation of means, standard deviations, and percentage changes. Preoperatively, mean ejection fraction was 48.2%. At 1 month, it increased to 51.7%, and at 3 months to 54.9%, consistent with early reverse remodelling. The most pronounced improvement was observed in patients with a baseline ejection fraction <50% (increase of 8-10%). Mitral valve repair was associated with more favourable early dynamics than replacement (7-9% vs 5-6%). Overall, 75% of patients demonstrated a positive trajectory as early as one month postoperatively. Surgical correction of mitral regurgitation is associated with a substantial early improvement in left ventricular systolic function. Ejection fraction dynamics within the first 1-3 postoperative months represent an important prognostic tool, enabling assessment of procedural efficacy, the rate of reverse remodelling, and optimisation of subsequent patient management
Received: 04.01.2026 | Revised: 17.04.2026 | Accepted: 26.05.2026
References
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2021;42(5):419–500. DOI: 10.1093/eurheartj/ehaa100 DOI: https://doi.org/10.1093/eurheartj/ehab626
Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease. Circulation. 2021;143(5):72–227. DOI: 10.1161/ CIR.0000000000000923 DOI: https://doi.org/10.1161/CIR.0000000000000923
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA Guideline for the management of heart failure. J Am Coll Cardiol. 2022;79(17):263–421. DOI: 10.1016/j.jacc.2021.12.012 DOI: https://doi.org/10.1016/j.jacc.2021.12.012
Lancellotti P, Pibarot P, Chambers J, La Canna G, Pepi M, Dulgheru R, et al. Multi-modality imaging assessment of native valvular regurgitation: An EACVI and ESC council of valvular heart disease position paper. Eur Heart J Cardiovasc Imaging. 2022;23(5):171–232. DOI: 10.1093/ehjci/jeab253 DOI: https://doi.org/10.1093/ehjci/jeab253
Coats AJS, Anker SD, Baumbach A, Alfieri O, von Bardeleben RS, Bauersachs J, et al. The management of secondary mitral regurgitation in patients with heart failure: A joint position statement from the HFA, EACVI, EHRA, and EAPCI of the ESC. Eur Heart J. 2021;42(13):1254–69. DOI: 10.1093/eurheartj/ehab086 DOI: https://doi.org/10.1093/eurheartj/ehab086
Witkowski TG, Thomas JD, Delgado V, van Rijnsoever E, Ng AC, Hoke U, et al. Changes in left ventricular function after mitral valve repair for severe organic mitral regurgitation. Ann Thorac Surg. 2012;93(3):754–60. DOI: 10.1016/j. athoracsur.2011.11.034 DOI: https://doi.org/10.1016/j.athoracsur.2011.11.034
Benfari G, Antoine C, Essayagh B, Batista R, Maalouf J, Rossi A, et al. Functional mitral regurgitation outcome and grading in heart failure with reduced ejection fraction. JACC Cardiovasc Imaging. 2021;14(12):2303–15.
DOI: 10.1016/j.jcmg.2021.05.017 DOI: https://doi.org/10.1016/j.jcmg.2021.05.017
Joung KW, Kim S, Nam JS, Choi YS, Shim JK, Lee S, et al. Changes in left ventricular ejection fraction after mitral valve repair for primary mitral regurgitation. J Clin Med. 2021;10(13):2830. DOI: 10.3390/jcm10132830 DOI: https://doi.org/10.3390/jcm10132830
Iung B, Messika-Zeitoun D, Boutitie F, Trochu JN, Armoiry X, Maucort-Boulch D, et al. Characteristics and outcome of patients eligible for the COAPT trial in the MITRA-FR trial. Circulation. 2020;142(25):2482–4. DOI: 10.1161/ CIRCULATIONAHA.120.049743 DOI: https://doi.org/10.1161/CIRCULATIONAHA.120.049743
Messika-Zeitoun D, Iung B, Armoiry X, Trochu JN, Donal E, Habib G, et al. Impact of mitral regurgitation severity and left ventricular remodeling on outcome after MitraClip implantation: Results from the MITRA-FR trial. JACC Cardiovasc Imaging. 2021;14(4):742–52. DOI: 10.1016/j.jcmg.2020.07.021 DOI: https://doi.org/10.1016/j.jcmg.2020.07.021
Suri RM, Schaff HV, Dearani JA, Sundt TM, Daly RC, Mullany CJ, et al. Recovery of left ventricular function after surgical correction of mitral regurgitation caused by leaflet prolapse. J Thorac Cardiovasc Surg. 2009;137(5):1071–6.
DOI: 10.1016/j.jtcvs.2008.10.026 DOI: https://doi.org/10.1016/j.jtcvs.2008.10.026
Mack MJ, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, et al. 3-year outcomes of transcatheter mitral valve repair in patients with heart failure. J Am Coll Cardiol. 2021;77(8):1029–40. DOI: 10.1016/j.jacc.2020.12.047 DOI: https://doi.org/10.1016/j.jacc.2020.12.047
Stone GW, Abraham WT, Lindenfeld J, Kar S, Grayburn PA, Lim S, et al. Five-year outcomes of transcatheter mitral valve repair in patients with heart failure. N Engl J Med. 2024;390(15):1395–404. DOI: 10.1056/NEJMoa2300213 DOI: https://doi.org/10.1056/NEJMoa2300213
Quintana E, Suri RM, Thalji NM, Daly RC, Dearani JA, Burkhart HM, et al. Left ventricular dysfunction after mitral valve repair – the fallacy of “normal” preoperative myocardial function. J Thorac Cardiovasc Surg. 2014;148(6):2752– 62. DOI: 10.1016/j.jtcvs.2014.07.029 DOI: https://doi.org/10.1016/j.jtcvs.2014.07.029
Tomšič A, de Weger A, van der Stoel M, Klautz RJM, Palmen M. Nationwide study: Mitral valve repair and replacement for active endocarditis. Ann Thorac Surg. 2024;117(1):120–6. DOI: 10.1016/j.athoracsur.2023.08.032 DOI: https://doi.org/10.1016/j.athoracsur.2023.08.032
Salsano A, Nenna A, Molinari N, Singh SSA, Spadaccio C, Santini F, et al. Impact of mitral regurgitation recurrence on mitral valve repair for secondary ischemic mitral regurgitation. J Cardiovasc Dev Dis. 2023;10(3):124. DOI: 10.3390/ jcdd10030124 DOI: https://doi.org/10.3390/jcdd10030124
Sudo M, Vij V, Wilde N, Tanaka T, Vogelhuber J, Silaschi M, et al. Contemporary treatment and outcomes of high surgical risk mitral regurgitation. J Clin Med. 2023;12(8):2978. DOI: 10.3390/jcm12082978 DOI: https://doi.org/10.3390/jcm12082978
Eapen SR, Zaky MH, Kostibas MP, Robich MP. Secondary mitral regurgitation surgical management: A narrative review. Cardiovasc Diagn Ther. 2024;14(5):958–73. DOI: 10.21037/cdt-24-6 DOI: https://doi.org/10.21037/cdt-24-6
Declaration of Helsinki [Internet]. [cited 2026 April 14]. Available from: https://www.wma.net
Dolgin E, editor. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. 9th ed. Boston: Little, Brown; 1994. 334 P.
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1–39. DOI: 10.1016/j. echo.2014.10.003 DOI: https://doi.org/10.1016/j.echo.2014.10.003
Osaulenko VV, Hubka VO, Chmul KO, Nakonechnyi SY, Budahov RI. Clinical outcomes of valve-sparing reconstructive surgery for ischemic mitral regurgitation: a 5-year single-center report and review of current global trends. Zaporozhye Med J. 2025;27(4):273–80. DOI: 10.14739/2310-1210.2025.4.331047 DOI: https://doi.org/10.14739/2310-1210.2025.4.331047
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