Can We Predict Failure of Mitral Valve Repair?

Simone Gasser,Christoph Sinning,Hermann Reichenspurner,Ulrich Schaefer,Evaldas Girdauskas,Maria Von Stumm

doi:10.3390/jcm8040526

Simone Gasser, Christoph Sinning + Show 4 more

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https://doi.org/10.3390/jcm8040526

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Abstract

Objective: To identify echocardiographic and surgical risk factors for failure after mitral valve repair. Methods: We identified a total of 77 consecutive patients from our institutional mitral valve surgery database who required redo mitral valve surgery due to recurrence of mitral regurgitation after primary mitral valve repair. A control group of 138 patients who had a stable echocardiographic long-term result was included based on propensity score matching. Systematic analysis of echocardiographic parameters was performed before primary surgery; after mitral valve repair and prior to redo surgery. Risk factor analysis was performed using multivariate Cox regression model. Results: Redo surgery was associated with the presence of pulmonary hypertension ≥ 50 mmHg (p = 0.02), a mean transmitral gradient > 5 mmHg (p = 0.001), left ventricular ejection fraction ≤ 45% (p = 0.05) before surgery and mitral regurgitation ≥moderate at time of discharge (p = 0.002) in the whole cohort. Patients with functional mitral valve regurgitation had a higher tendency to undergo redo surgery if preoperative left ventricular end-diastolic diameter exceeded 65 mm (p = 0.043) and if postoperative tenting height exceeded 6 mm (p = 0.018). Low ejection fraction was not significantly associated with the need for redo mitral valve surgery in the functional subgroup. Conclusions: Recurrent mitral regurgitation is still a valuable problem and is associated with relevant perioperative mortality. Patients with severe mitral regurgitation should undergo early mitral valve repair surgery as long as systolic pulmonary artery pressure is low, left ventricular ejection fraction is preserved, and LVEED is deceeds 65 mm.

Highlights

Mitral valve dysfunction (MVD) is the second most common form of heart valve disease in adults [1]
Two main pathophysiological entities of MVD exist which are completely different in terms of their treatment strategies and prognosis: Degenerative MV is the most frequent mechanism of mitral regurgitation (MR) and leads to leaflet prolapse due to elongation or rupture of chordal apparatus or, less frequently, to restrictive leaflet motion due to calcification or inflammation
Ischemic MR is characterized by restrictive mitral leaflet motion during the systole due to left ventricle (LV) remodeling which occurs as a sequel of ischemic heart disease (Carpentier Type IIIb dysfunction) [1]

Summary

Introduction

Mitral valve dysfunction (MVD) is the second most common form of heart valve disease in adults [1]. An increased motion of the free edge of one or both leaflets overriding MV annular plane during the systole is defined as leaflet prolapse (Carpentier Type II dysfunction). Ischemic mitral incompetence leading to functional mitral regurgitation (FMR) is the most frequent mechanism of MR in developed countries [1]. It results from a global and/or regional left ventricular remodeling which leads to the distortion of the whole MV apparatus, including chordae, annulus, and leaflets. Ischemic MR is characterized by restrictive mitral leaflet motion during the systole due to left ventricle (LV) remodeling which occurs as a sequel of ischemic heart disease (Carpentier Type IIIb dysfunction) [1]. Patients with type I dysfunction have an extensive MV annulus dilatation and normal leaflet motion, with the free edges of the leaflets positioned 5 to 10 mm below the plane of the annulus due to annular dilatation [1]

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