Risk Factors Of Poor Prognosis Of Mitral Valve Repair Were Analyzed Based On Logistic Regression Model

Background:Mitral regurgitation is the most common heart valve disease in China.Mitral valve repair surgery is currently an effective surgical method for its treatment,but reducing the postoperative recurrence rate of mitral regurgitation and surgical mortality still remain challenging.Currently,the prognosis indicators for mitral valve repair surgery are not ideal.In addition,the surgeon’s experience is also a key influencing factor on the effectiveness of mitral valve repair surgery.However,there is very little research on related cases of the same surgeon.Therefore,to improve the prognosis of mitral valve repair patients,it is necessary to further explore indicators that have higher clinical value.Objectives:The aim of this study was to investigate the risk factors that impact the prognosis of mitral valve repair and establish a preliminary risk prediction model to guide clinical identification of high-risk patients for surgical decision-making.Please proofread and correct any errors in the sentence.Methods:A total of 83 patients who underwent mitral valve repair by the same surgeon at the Cardiovascular Surgery Department of Zhujiang Hospital,Southern Medical University between July 2020 and September 2022 were retrospectively screened.Single-factor analysis and multivariable logistic regression analysis were used to screen for risk factors that influence the prognosis of mitral valve repair and establish a multivariate logistic regression model.Subgroup analysis was performed on patients with moderate to severe recurrent mitral regurgitation after surgery to explore the influencing factors of mitral regurgitation recurrence and establish a multivariate logistic regression model for predicting early postoperative mitral regurgitation recurrence after mitral valve repair surgery.Results:1.A total of 83 patients who underwent mitral valve repair surgery were included.During follow-up,19(22.9%)patients experienced outcome events,including 4(4.8%)patients who died early post-surgery.Of the patients,15(18.1%)cases experienced postoperative recurrence of severe mitral regurgitation,10 of which were readmitted for treatment due to heart failure.There were no deaths or repeat mitral valve surgeries among the patients with severe mitral regurgitation after surgery.There is no significant difference in the etiology of mitral regurgitation between patients with a poor prognosis and those with a good prognosis(P>0.05).2.Stepwise regression analysis revealed that blood urea nitrogen(OR=1.134,P<0.05)and cardiopulmonary bypass time(OR=1.014,P<0.05)were independent risk factors for the prognosis of mitral valve repair.The logistic regression model for predicting the prognosis using blood urea nitrogen and cardiopulmonary bypass time as independent variables,has an Omnibus test P value of 0.007<0.01,indicating statistical significance,and a Hosmer-Lemeshow goodness-of-fit test P value of 0.084>0.05,indicating good fit to the data.The ROC curve shows that the AUC is 0.701(95%CI:0.549～0.854),with a predicted sensitivity of 57.9%and specificity of 87.5%.3.In the subgroup analysis,stepwise regression analysis revealed that blood urea nitrogen(OR=1.191,P<0.05)and age(OR=1.073,P<0.05)were identified as independent risk factors for early postoperative mitral regurgitation recurrence after mitral valve repair surgery,while the use of more than two repair techniques(OR=0.157,P<0.05)was identified as a protective factor.The logistic regression model was constructed using blood urea nitrogen,age,and the use of more than two repair techniques as independent variables to predict early postoperative mitral regurgitation recurrence.The model coefficient Omnibus test showed a P value of 0.003<0.01,a Hosmer-Lemeshow goodness-of-fit test P value of 0.456>0.05.The ROC curve shows that the AUC is 0.775(95%CI:0.646～0.904),with a predicted sensitivity of 93.3%and specificity of 48.4%.4.Subgroup analysis showed that recurrence of mitral regurgitation after mitral valve repair is associated with larger left atrium and higher pulmonary artery pressure in the early postoperative period(P<0.05).Conclusions:Blood urea nitrogen and cardiopulmonary bypass time are independent risk factors for prognosis in mitral valve repair,which can help clinicians in identifying patients at high risk for mitral valve repair and making appropriate surgical decisions.