Details

Autor(en) / Beteiligte

• Bouma, Wobbe, MD
• Lai, Eric K., BS
• Levack, Melissa M., MD
• Shang, Eric K., MD
• Pouch, Alison M., PhD
• Eperjesi, Thomas J., BS
• Plappert, Theodore J., CVT
• Yushkevich, Paul A., PhD
• Mariani, Massimo A., MD, PhD
• Khabbaz, Kamal R., MD
• Gleason, Thomas G., MD
• Mahmood, Feroze, MBBS
• Acker, Michael A., MD
• Woo, Y. Joseph, MD
• Cheung, Albert T., MD
• Jackson, Benjamin M., MD
• Gorman, Joseph H., MD
• Gorman, Robert C., MD

Titel

Preoperative Three-Dimensional Valve Analysis Predicts Recurrent Ischemic Mitral Regurgitation After Mitral Annuloplasty

Ist Teil von

• The Annals of thoracic surgery, 2016-02, Vol.101 (2), p.567-575

Ort / Verlag

Netherlands: Elsevier Inc

Erscheinungsjahr

2016

Quelle

MEDLINE

Beschreibungen/Notizen

• Background Valve repair for ischemic mitral regurgitation (IMR) with undersized annuloplasty rings is characterized by high IMR recurrence rates. Patient-specific preoperative imaging-based risk stratification for recurrent IMR would optimize results. We sought to determine if prerepair three-dimensional (3D) echocardiography combined with a novel valve-modeling algorithm would be predictive of IMR recurrence 6 months after repair. Methods Intraoperative transesophageal real-time 3D echocardiography was performed in 50 patients undergoing undersized ring annuloplasty for IMR and in 21 patients with normal mitral valves. A customized image analysis protocol was used to assess 3D annular geometry and regional leaflet tethering. IMR recurrence (≥ grade 2) was assessed with two-dimensional transthoracic echocardiography 6 months after repair. Results Preoperative annular geometry was similar in all IMR patients, and preoperative leaflet tethering was significantly higher in patients with recurrent IMR (n=13) than in patients in whom IMR did not recur (n=37) (tethering index: 3.91 ± 1.01 vs 2.90 ± 1.17, p  = 0.008; tethering angles of A3: 23.5° ± 8.9° vs 14.4° ± 11.4°, p  = 0.012; P2: 44.4° ± 8.8° vs 28.2° ± 17.0°, p  = 0.002; and P3: 35.2° ± 6.0° vs. 18.6° ± 12.7°, p < 0.001). Multivariate logistic regression analysis revealed the preoperative P3 tethering angle as an independent predictor of IMR recurrence with an optimal cutoff value of 29.9° (area under the curve, 0.92; 95% confidence interval, 0.84 to 1.00; p < 0.001). Conclusions 3D echocardiography combined with valve modeling is predictive of recurrent IMR. Preoperative regional leaflet tethering of segment P3 is a strong independent predictor of IMR recurrence after undersized ring annuloplasty. In patients with a preoperative P3 tethering angle of 29.9° or larger, chordal-sparing valve replacement rather than valve repair should be strongly considered.