title: Echocardiographic predictors of successful versus unsuccessful mitral valve repair in ischemic mitral regurgitation.
abstract: Mitral valve (MV) annuloplasty is the standard surgical technique for the management of ischemic mitral regurgitation (MR). However, < or = 1/3 of patients develop recurrent MR after annuloplasty. Therefore, we sought to identify the preoperative echocardiographic parameters that predict annuloplasty failure in patients with ischemic MR. Intraoperative transesophageal echocardiograms from 365 patients who underwent MV repair for ischemic MR were reviewed. Of the 365 patients, 297 (81%) had satisfactory outcomes with < 2+ MR, and 68 (19%) had recurrent MR (> or = 2+) during a mean follow-up of 269 days. The mitral annular parameters, including mitral annular diameter, tethering height, and tethering area of the mitral leaflets, were determined in 3 different echocardiographic views. On multiple logistic stepwise regression analysis, a higher mitral annular diameter, higher tethering area, and higher MR severity were identified as independent predictors for failure of MV repair (p < 0.0001). In conclusion, these results demonstrated that preoperative echocardiographic findings can be used to identify patients with ischemic MR at increased risk of repair failure. These echocardiographic measurements should be used to guide the cardiologist and cardiac surgeon in the choice of MV repair versus replacement in patients with ischemic MR.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Vorachai
authors.initials: V
authors.lastname: Kongsaerepong
authors.forename: Maiko
authors.initials: M
authors.lastname: Shiota
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Song
authors.forename: Shota
authors.initials: S
authors.lastname: Fukuda
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McCarthy
authors.forename: Timothy
authors.initials: T
authors.lastname: Williams
authors.forename: Robert
authors.initials: R
authors.lastname: Savage
authors.forename: Masao
authors.initials: M
authors.lastname: Daimon
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shiota
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging*; D015588:Observer Variation; D011379:Prognosis; D012189:Retrospective Studies