TY - JOUR
T1 - Mitral valve geometry and hemodynamics after surgical mitral valve annuloplasty and implications for percutaneous treatment of patients with recurrent mitral regurgitation
AU - Al Amri, Ibtihal
AU - Debonnaire, Philippe
AU - Witkowski, Tomasz
AU - van der Kley, Frank
AU - Palmen, Meindert
AU - de Weger, Arend
AU - Klautz, Robert J.
AU - Bax, Jeroen J.
AU - Schalij, Martin J.
AU - Ajmone Marsan, Nina
AU - Delgado, Victoria
PY - 2013
Y1 - 2013
N2 - The feasibility of transcatheter mitral valve therapy (edge-to-edge or valve-in-ring technique) in patients with significant mitral regurgitation (MR) recurrence after surgical restrictive mitral valve annuloplasty remains unknown. The aim of the present study was to investigate the eligibility for transcatheter mitral valve therapy of high-surgical-risk patients with significant MR recurrence after initial successful restrictive mitral valve annuloplasty. A total of 47 patients (age 67 ± 10 years, 47% men) with significant MR recurrence (effective regurgitant orifice area ≥20 mm 2, regurgitant volume ≥30 ml/beat, or vena contracta ≥3 mm) after restrictive mitral valve annuloplasty were identified. The long-term outcome of patients dichotomized according to the surgical risk was evaluated. The echocardiographic parameters of mitral valve geometry and hemodynamics at the moment of diagnosis of MR recurrence were assessed to evaluate the eligibility for transcatheter valve therapy. During a median follow-up of 3 years, 23 patients (48.9%) died. The patients with a high-surgical risk (logistic European System for Cardiac Operative Risk Evaluation score ≥20%) had significantly worse long-term survival than those with a low-surgical risk (logistic European System for Cardiac Operative Risk Evaluation score <20%; 50% and 88%, respectively; p = 0.002). All high-surgical-risk patients showed geometric mitral valve features that would allow transcatheter mitral valve therapy (mitral annular area 7 ± 2.0 cm2, coaptation length 6 ± 1.6 mm, anterior and posterior mitral leaflet length 24 ± 2.8 mm and 15 ± 3.1 mm, respectively). In conclusion, patients with significant MR recurrence after initial successful restrictive mitral valve annuloplasty and a high risk of redo mitral valve surgery had lower long-term survival rates than patients who could undergo repeat surgery. © 2013 Elsevier Inc. All rights reserved.
AB - The feasibility of transcatheter mitral valve therapy (edge-to-edge or valve-in-ring technique) in patients with significant mitral regurgitation (MR) recurrence after surgical restrictive mitral valve annuloplasty remains unknown. The aim of the present study was to investigate the eligibility for transcatheter mitral valve therapy of high-surgical-risk patients with significant MR recurrence after initial successful restrictive mitral valve annuloplasty. A total of 47 patients (age 67 ± 10 years, 47% men) with significant MR recurrence (effective regurgitant orifice area ≥20 mm 2, regurgitant volume ≥30 ml/beat, or vena contracta ≥3 mm) after restrictive mitral valve annuloplasty were identified. The long-term outcome of patients dichotomized according to the surgical risk was evaluated. The echocardiographic parameters of mitral valve geometry and hemodynamics at the moment of diagnosis of MR recurrence were assessed to evaluate the eligibility for transcatheter valve therapy. During a median follow-up of 3 years, 23 patients (48.9%) died. The patients with a high-surgical risk (logistic European System for Cardiac Operative Risk Evaluation score ≥20%) had significantly worse long-term survival than those with a low-surgical risk (logistic European System for Cardiac Operative Risk Evaluation score <20%; 50% and 88%, respectively; p = 0.002). All high-surgical-risk patients showed geometric mitral valve features that would allow transcatheter mitral valve therapy (mitral annular area 7 ± 2.0 cm2, coaptation length 6 ± 1.6 mm, anterior and posterior mitral leaflet length 24 ± 2.8 mm and 15 ± 3.1 mm, respectively). In conclusion, patients with significant MR recurrence after initial successful restrictive mitral valve annuloplasty and a high risk of redo mitral valve surgery had lower long-term survival rates than patients who could undergo repeat surgery. © 2013 Elsevier Inc. All rights reserved.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84881609518&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/23711814
U2 - https://doi.org/10.1016/j.amjcard.2013.04.044
DO - https://doi.org/10.1016/j.amjcard.2013.04.044
M3 - Article
C2 - 23711814
SN - 0002-9149
VL - 112
SP - 714
EP - 719
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 5
ER -