Predictive Value of Pre-Operative 2D and 3D Transthoracic Echocardiography in Patients Undergoing Mitral Valve Repair: Long Term Follow Up of Mitral Valve Regurgitation Recurrence and Heart Chamber Remodeling.

Gloria Tamborini,Mauro Pepi,Valentina Mantegazza,Paola Gripari,Gianpiero Italiano,Manuela Muratori,Enrico G Caiani,Valentina Volpato,Marco Zanobini,Marco Penso,Sarah Ghulam Ali,Laura Fusini,Claudia Cefalù

doi:10.3390/jcdd7040046

Gloria Tamborini, Mauro Pepi + Show 11 more

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https://doi.org/10.3390/jcdd7040046

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Abstract

The “ideal” management of asymptomatic severe mitral regurgitation (MR) in valve prolapse (MVP) is still debated. The aims of this study were to identify pre-operatory parameters predictive of residual MR and of early and long-term favorable remodeling after MVP repair. We included 295 patients who underwent MV repair for MVP with pre-operatory two- and three-dimensional transthoracic echocardiography (2DTTE and 3DTTE) and 6-months (6M) and 3-years (3Y) follow-up 2DTTE. MVP was classified by 3DTTE as simple or complex and surgical procedures as simple or complex. Pre-operative echo parameters were compared to post-operative values at 6M and 3Y. Patients were divided into Group 1 (6M-MR < 2) and Group 2 (6M-MR ≥ 2), and predictors of MR ≥ 2 were investigated. MVP was simple in 178/295 pts, and 94% underwent simple procedures, while in only 42/117 (36%) of complex MVP a simple procedure was performed. A significant relation among prolapse anatomy, surgical procedures and residual MR was found. Post-operative MR ≥ 2 was present in 9.8%: complex MVP undergoing complex procedures had twice the percentage of MR ≥ 2 vs. simple MVP and simple procedures. MVP complexity resulted independent predictor of 6M-MR ≥ 2. Favorable cardiac remodeling, initially found in all cases, was maintained only in MR < 2 at 3Y. Pre-operative 3DTTE MVP morphology identifies pts undergoing simple or complex procedures predicting MR recurrence and favorable cardiac remodeling.

Highlights

Myxomatous or degenerative mitral valve (MV) disease is the leading cause of MV prolapse (MVP) and surgically correctable mitral regurgitation (MR) in the developed world
The aims of this study in a large series of patient undergoing MV repair for severe MVP were: (a) to evaluate whether 3DTTE may identify cases undergoing simple vs. complex surgical procedures based on the MVP complexity; (b) to correlate MVP complexity and surgical techniques to outcomes in terms of 6 months (6M) and 3 years (3Y) MR residual severity; (c) to correlate all these findings to left chamber remodeling and functional and hemodynamic parameters at 6M and 3Y follow-up
We identified from the baseline parameters the complex MVP, complex procedure, Pulmonary artery systolic pressure (PASP) as independent predictors of the MR at 6M

Summary

Introduction

Myxomatous or degenerative mitral valve (MV) disease is the leading cause of MV prolapse (MVP) and surgically correctable mitral regurgitation (MR) in the developed world. The correct timing of MV repair is still under debate, and discordance between observational investigations of watchful waiting and early surgery management strategies drives the continued controversy surrounding this issue [2,3,4,5] In this regard, recent guidelines stated that MV repair can be considered in asymptomatic patients when there is a high likelihood of durable result at very low risk (

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