712-3 Predictive Value of Intraoperative Transesophageal Color Doppler Flow Imaging During Mitral Valve Repair

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.