Abstract 18555: Pre-operative Three-Dimensional Echocardiography Predicts Repair Failure in Ischemic Mitral Regurgitation

Abstract

Objective: Early recurrence (≤ 6 months) of mitral regurgitation after ring annuloplasty for ischemic mitral regurgitation (IMR) is common. We hypothesized that the degree of pre-repair leaflet tethering as assessed by a novel three-dimensional (3D) echocardiographic based algorithm would be a sensitive predictor of repair failure within 6 months of surgery. Methods: Real-time 3D full volume transesophegeal echocardiography loops were acquired on patients (N=12) undergoing mitral valve repair for IMR. Images were segmented using previously described methodology. Using custom algorithms, leaflets were divided into six regions for calculation of the respective degree of tethering in each leaflet region. Patients received 2D echocardiography follow-up six months after surgery to assess for recurrence of MR. Pre-operative tethering of patients who recurred were compared to those who did not recur to identify predictors of repair failure. Students’ t-tests were used to compare groups; to account for multiple dependent variables, P<.026 was considered statistically significant (Bonferroni correction). Results: 33% of patients had moderate to severe MR at the six month follow-up. The degree of horizontal tethering for the P3 leaflet region was 13.77 ± 4.29º compared to 36.71 ± 8.04º (P<0.001) in the group which recurred. Repair failure at six months was predicted by A3 and P3 horizontal tethering angles. (Table 1) Tenting index and 2D echocardiography measurements of left ventricular size and ejection fraction were not predictive of failure. Conclusions: Pre-operative 3D posterior leaflet tethering is predictive of mitral valve repair failure. Three-dimensional modeling may aid in determining which patients should undergo replacement rather than repair in IMR.