Heart failurePredictors of Mitral Regurgitation Recurrence in Patients With Heart Failure Undergoing Mitral Valve Annuloplasty
Section snippets
Methods
A total of 122 patients with HF and moderate to severe MR were included. The patients were scheduled for restrictive mitral annuloplasty, accompanied by coronary artery bypass grafting if indicated. In patients with HF with idiopathic cardiomyopathy, restrictive mitral annuloplasty was performed with concomitant placement of a CorCap (Acorn Cardiovascular, St. Paul, Minnesota) cardiac support device if significant LV dilation (LV diameter >65 mm) was measured on the preoperative
Results
The demographic, clinical, and surgical characteristics of the patients are listed in Table 1. The mean age was 62 ± 11 years, and 61% of patients were men. Most patients (85%) had New York Heart Association functional class III or IV. Patients were receiving optimal medical treatment for HF. No clinically relevant difference was found in the demographic or clinical characteristics between the patients with recurrent MR and those without recurrent MR at mid-term follow-up.
In 37% of patients,
Discussion
The results of the present study have identified baseline echocardiographic predictors of mid-term recurrent MR after restrictive mitral annuloplasty for functional MR. In a cohort of patients with HF of ischemic or nonischemic origin, distal mitral anterior leaflet tethering, as estimated by the ALAtip, and posterior leaflet tethering, as estimated by the PLA, were independent predictors of recurrent MR after mitral annuloplasty.
The spherical shape of the left ventricle plays an important role
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Commentary: The right horse for the race in the repair of secondary mitral regurgitation
2023, Journal of Thoracic and Cardiovascular SurgeryPreoperative assessment of mitral valve regurgitation with two- and three-dimensional transesophageal echocardiography
2022, Cirugia CardiovascularCitation Excerpt :Indeed, in patients without advanced LV remodeling and severe leaflet tethering, mitral valve repair with an undersized complete ring may offer satisfactory results.45 Conversely, in patients with echocardiographic predictors of annuloplasty failure46–48 (Table 4), additional valvular/subvalvular techniques or chordal sparing valve replacement should be considered to achieve a more durable solution.49 Nevertheless, it is important to acknowledge that no one of these singular echocardiographic parameters demonstrated a strong and highly reproducible association with annuloplasty failure, while discrepant results have been reported by different studies on this topic.50,51
Mitral Regurgitation in 2020: The 2020 Focused Update of the 2017 American College of Cardiology Expert Consensus Decision Pathway on the Management of Mitral Regurgitation
2021, Journal of Cardiothoracic and Vascular AnesthesiaImpact of Mitral Regurgitation Recurrence on Mitral Valve Repair for Secondary Ischemic Mitral Regurgitation
2023, Journal of Cardiovascular Development and DiseaseSplitting the anterior mitral leaflet impairs left ventricular function in an ovine model
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Dr. Ciarka received a training grant in noninvasive imaging in cardiology from the European Society of Cardiology (Sophia Antipolis, France) and a grant from the Horlait-Dapsens Foundation (Brussels, Belgium). Dr. Bax received grants from Biotronik (Berlin, Germany), Medtronic (Minneapolis, Minnesota), Boston Scientific Corporation (Natic, Massachusetts), Bristol-Myers Squibb Medical Imaging (New York, New York), St Jude Medical (St. Paul, Minnesota), GE Healthcare (Milwaukee, Wisconsin), and Edwards Lifesciences (Irving, California). Dr. Dion is on the speakers' bureau of Edwards Lifesciences (Irving, California).