RF38 LATE PREDICTORS OF MITRAL REGURGITATION RECURRENCE AFTER SURGERY FOR FUNCTIONAL MITRAL REGURGITATION IN ISCHEMIC HEART FAILURE: FIX THE LEFT VENTRICLE TO IMPROVE MITRAL REPAIR DURABILITY.

Abstract

Background and aim: to analyse predictors of functional mitral regurgitation recurrence (MRR) after Surgical Ventricular Reconstruction (SVR) and mitral annuloplasty in ischemic heart failure (EF < 35%). Methods: Between January 2001 and March 2016, a consecutive series of 172 patients (mean age 64 ± 8 years) was operated of SVR and mitral annuloplasty for anterior [AR = 128 (74%)] or posterior [PR = 44 (26%)] post-ischemic remodeling and functional MR. Echocardiographic follow-up (mean: 51 months) was available in 131 patients. MR grade >2 was defined as MR recurrence (MRR). Independent predictors of MRR were calculated with univariate (Kaplan-Meier) and multivariate (Cox regression) analysis. Results: MRR occurred in 27 patients (18%), and was significantly associated with higher 5-years mortality (52% vs 18%, p < .001) and HF readmission rate (55% vs 22%, p < .001). MRR was significantly lower in posterior compared to anterior remodelling (9%vs 18%, p = .03). Left ventricle volumes (ΔESV = -29%; ΔEDV = -22%) were significantly reduced both in patient without or with MRR, but the latter exhibited a significant post SVR sphericalization (ΔSpher Index: +37%vs +7%; p = .01), which significantly correlates with increased mitral tenting area (R2 = 0.36; 3.5 cmq vs 2.6 cmq; p = .002). Multivariate Cox regression analysis showed anterior remodeling (p = .01) and Sphericity Index (p = .01) as independent predictors of MRR. ROC analysis identified a cut-off value of 0.66 (sensibility = 78%; specificity = 67%) for SpherI (3-years freedom from MRR: 54% vs 18%,p = .001). Conclusions: In functional MR and ischemic HF, SVR improves long-term durability of mitral annuloplasty, especially in posterior remodelling. LV sphericalization and anterior remodeling correlate to higher probability of MRR at follow-up so, in this settings, valve replacement rather than repair should be considered.