Vol 26, No 4 (2019)
Original articles — Clinical cardiology
Published online: 2018-03-02

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Predicting functional mitral stenosis after restrictive annuloplasty for ischemic mitral regurgitation

Baotong Li1, Hengchao Wu1, Hansong Sun1, Jianping Xu1, Yunhu Song1, Wei Wang1, Shuiyun Wang1
Pubmed: 29512090
Cardiol J 2019;26(4):350-359.

Abstract

Background: Although it has been realized that restrictive mitral valve annuloplasty (MVA) may re­sult in clinically significant functional mitral stenosis (MS), it still cannot be predicted. The purpose of this study was to identify risk factors for clinically significant functional MS following restrictive MVA surgery for chronic ischemic mitral regurgitation (CIMR).

Methods: One hundred and fourteen patients who underwent restrictive MVA with coronary artery bypass grafting (CABG) for treatment of CIMR were retrospectively reviewed. Clinically significant functional MS was defined as resting transmitral peak pressure gradient (PPG) 13 mmHg.

Results: During the follow-up period (range 6–12 months), 28 (24.56%) patients developed clinically significant functional MS. The PPG at follow-up was significantly higher than that measured in the early postoperative stage (3–5 days after surgery). Moreover, there was a linear correlation between the two measurements (r = 0.398, p < 0.001). Annuloplasty size 27 mm and early postoperative PPG 7.4 mmHg could predict clinically significant functional MS at 6–12 months postoperatively.

Conclusions: Chronic ischemic mitral regurgitation patients treated with restrictive MVA and CABG have significant increases in PPG postoperatively. Annuloplasty size 27 mm and early postopera­tive PPG 7.4 mmHg can predict clinically significant functional MS at 6–12 months after surgery.

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References

  1. Kron IL, Acker MA, Adams DH, et al. American Association for Thoracic Surgery Ischemic Mitral Regurgitation Consensus Guidelines Writing Committee. 2015 The American Association for Thoracic Surgery Consensus Guidelines: Ischemic mitral valve regurgitation. J Thorac Cardiovasc Surg. 2016; 151(4): 940–956.
  2. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 2014; 148(1): e1–e132.
  3. Rubino AS, Onorati F, Santarpia G, et al. Impact of increased transmitral gradients after undersized annuloplasty for chronic ischemic mitral regurgitation. Int J Cardiol. 2012; 158(1): 71–77.
  4. Fino C, Iacovoni A, Ferrero P, et al. Restrictive mitral valve annuloplasty versus mitral valve replacement for functional ischemic mitral regurgitation: an exercise echocardiographic study. J Thorac Cardiovasc Surg. 2014; 148(2): 447–53.e2.
  5. Magne J, Sénéchal M, Mathieu P, et al. Restrictive annuloplasty for ischemic mitral regurgitation may induce functional mitral stenosis. J Am Coll Cardiol. 2008; 51(17): 1692–1701.
  6. Kubota K, Otsuji Y, Ueno T, et al. Functional mitral stenosis after surgical annuloplasty for ischemic mitral regurgitation: importance of subvalvular tethering in the mechanism and dynamic deterioration during exertion. J Thorac Cardiovasc Surg. 2010; 140(3): 617–623.
  7. Cahalin LP, Mathier MA, Semigran MJ, et al. The six-minute walk test predicts peak oxygen uptake and survival in patients with advanced heart failure. Chest. 1996; 110(2): 325–332.
  8. Kainuma S, Taniguchi K, Daimon T, et al. Does stringent restrictive annuloplasty for functional mitral regurgitation cause functional mitral stenosis and pulmonary hypertension? Circulation. 2011; 124(11 Suppl): S97–106.
  9. Lorusso R, Gelsomino S, Vizzardi E, et al. Mitral valve repair or replacement for ischemic mitral regurgitation? The Italian Study on the Treatment of Ischemic Mitral Regurgitation (ISTIMIR). J Thorac Cardiovasc Surg. 2013; 145(1): 128–139.
  10. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005; 18(12): 1440–1463.
  11. Murashita T, Greason KL, Suri RM, et al. Mitral valve gradient after valve repair of degenerative regurgitation with restrictive annuloplasty. J Thorac Cardiovasc Surg. 2016; 151(1): 106–109.
  12. Bertrand PB, Gutermann H, Smeets CJP, et al. Functional impact of transmitral gradients at rest and during exercise after restrictive annuloplasty for ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2014; 148(1): 183–187.
  13. Lawson WE, Seifert F, Anagnostopoulos C, et al. Effect of coronary artery bypass grafting on left ventricular diastolic function. Am J Cardiol. 1988; 61(4): 283–287.
  14. Williams ML, Daneshmand MA, Jollis JG, et al. Mitral gradients and frequency of recurrence of mitral regurgitation after ring annuloplasty for ischemic mitral regurgitation. Ann Thorac Surg. 2009; 88(4): 1197–1201.
  15. Bertrand PB, Verbrugge FH, Verhaert D, et al. Mitral valve area during exercise after restrictive mitral valve annuloplasty: importance of diastolic anterior leaflet tethering. J Am Coll Cardiol. 2015; 65(5): 452–461.
  16. Kawamoto N, Fujita T, Hata H, et al. Prosthesis-patient mismatch due to small ring annuloplasty in patients with degenerative mitral insufficiency. J Cardiol. 2016; 68(2): 141–147.