title: Annular-to-leaflet mismatch and the need for reductive annuloplasty in patients undergoing mitral repair for chronic mitral regurgitation due to mitral valve prolapse.
abstract: Annular dilation is a common feature of chronic degenerative mitral regurgitation caused by leaflet prolapse. Accordingly, patients undergoing surgical repair usually undergo concomitant reductive annuloplasty to restore a normal annular-to-leaflet relation. With the evolution of transcatheter valve repair technologies, patient selection criteria for those who do not require annuloplasty are needed. A series of patients undergoing mitral repair was analyzed, and the role of annular-to-leaflet mismatch in identifying patients requiring reductive annuloplasty was explored. Preoperative data for 82 patients undergoing mitral repair with annuloplasty for degenerative mitral regurgitation were prospectively collected, including annular intercommissural (IC) and septolateral (SL) dimensions and heights of anterior (ALH) and posterior leaflets. An SL/ALH ratio >1.4 was used to define annular-to-leaflet mismatch. After mitral repair, the ratio between preoperative IC distance and the size of the implanted annular prosthesis (Seguin ring [SR], IC/SR <1.2) was used to identify patients for whom annuloplasty was nonreductive. All patients underwent successful mitral repair. Mean preoperative IC was 46 +/- 6 mm, SL was 42 +/- 5 mm, and ALH was 31 +/- 5 mm. Mean SR was 34 +/- 3 mm, with a mean IC/SR ratio of 1.34 +/- 0.14. Sixteen patients (19%) had an IC/SR ratio <1.2. IC/SR ratio <1.2 was predicted by a SL/ALH ratio < or =1.4 (p = 0.009). In conclusion, annular dilation is negligible in <20% of surgical candidates. In this subgroup, an isolated leaflet repair may be indicated. SL/ALH ratio is a good indicator of annular-to-leaflet mismatch and could be used as an adjunct to other methods of annular function assessment to select patients for ringless mitral repair.
authors.affiliation: Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Giovanni
authors.initials: G
authors.lastname: La Canna
authors.forename: Antonio
authors.initials: A
authors.lastname: Grimaldi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Viganò
authors.forename: Andrea
authors.initials: A
authors.lastname: Blasio
authors.forename: Andrea
authors.initials: A
authors.lastname: Mignatti
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Attilio
authors.initials: A
authors.lastname: Maseri
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004108:Dilatation, Pathologic / Q000209:etiology; D004452:Echocardiography; D005260:Female; D006301:Health Services Needs and Demand; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D012044:Regression Analysis; D012107:Research Design; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D016896:Treatment Outcome