OC19 DETERMINANTS OF FUNCTIONAL CAPACITY AFTER RESTRICTIVE ANNULOPLASTY FOR ISCHEMIC MITRAL REGURGITATION

Abstract

OBJECTIVE(S): This study was designed to evaluate prevalence and determinants of reduced functional capacity, in patients who underwent restrictive mitral valve annuloplasty (RMA) for severe ischemic mitral regurgitation (IMR). METHODS: Between January 2008 and December 2015, 90 patients with severe ischemic mitral regurgitation underwent coronary artery bypass grafting and restrictive mitral valve annuloplasty. After a mean period of 3.5 +/- 2.4years, cardiopulmonary exercise testing (CPET) was performed to assess peak oxygen consumption (VO2 max). RESULTS: At five years, survival was 68.8+/-5.3%. The mean VO2 max was 17.4+/-4 ml/kg/min (76.3+/-2% of the age predicted) but varied widely (32% to 121% of predicted) and was markedly reduced (<80% of predicted) in 37 patients (63%). Linear regression identifiedkidney function (Creatinine clearance, p < 0.01), preoperative functional capacity (NYHA > 4, p = 0.01), triple vessel disease (p = 0.03), BMI (p < 0.01), preoperative left ventricular end-diastolic volume (p = 0.04) and left ventricular systolic diameter (p = 0.04) as independent determinants of reduced VO2 max. No patients needed a mitral valve reoperation, freedom from more than moderate mitral regurgitation was 83.5+/-6.7 % at 5 years. CONCLUSIONS: Even with a relative low rate of IMR recurrence, functional capacity quantitatively assessed by CPET is markedly reduced in nearly two out of three patients after restrictive mitral valve annuloplasty. Reduced peak VO2 is independently determined by patient comorbidity, extensive coronary disease, left ventricle dimensions and preoperative functional status, but not by recurrence of IMR.