Abstract
To assess the predictive value of Residual Mitral Regurgitation (RMR) after valve repair for severe MR, we performed transesophageal color (TEE) Doppler flow imaging intraoperatively, after 3 months and 1 year at similar loading conditions in a prospective study of 178 patients (pts). Intraoperative grading of RMR on a 4 point scale in 159 pts showed no RMR in 77 pts, grade I in 45, grade II in 29 and grade III in 8 pts. Univariate analysis of preoperative and surgical characteristics showed that a history of chronic lung disease (Relative Risk (RR) 1.88 * ), increased leaflet mobility (RR 1.50 * ) and normal leaflet mobility (RR 1.51 * ) at TEE, coronary artery disease (RR 1.38), and a Duran annular ring (RR 1.97 * ) were associated with an increased risk of intraoperative RMR. In the 8 pts with grade III RMR, immediate valve replacement (VR) was advised and performed in all but one pt, who underwent VR 2 months later. After 3 months, increase of RMR (of at least one grade) was present in 63%, reduction in 8% and no change in 29% of the pts. Compared to three months, no increase or decrease of RMR was seen at 1 year. During the one year follow-up VR was performed in another 7 pts; all but one pt (no RMR) with intraoperative RMR grade I-II. Intraoperative RMR grade I-II was associated with a higher risk of VR (RR 6.51 * ) and thromboembolic events (RR 6.51 * ) in relation to absence of RMR, during this one year follow-up. (1) RMR increases in most pts within 3 months postoperatively and is stable thereafter. (2) Intraoperative RMR is associated with a substantial reoperation rate and risk of thromboembolic events. 131 RMR S grade II does not exclude a redo during one year follow-up. * = P < 0.05.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have