Mitral valve repair for dilated cardiomyopathy: predictive role of right ventricular dysfunction.
OBJECTIVE
To evaluate the impact of right ventricular (RV) dysfunction on early and mid-term outcome of patients with ischaemic or dilated cardiomyopathy (DCM) undergoing mitral valve annuloplasty.


RESULTS
From January 1997 to December 2005, 111 patients with DCM (89 ischaemic, 22 non-ischaemic) were enrolled in this retrospective study. Mean age was 67 +/- 10 years. Average pre-operative NYHA class was 3.0 +/- 0.6. Tricuspid annular plane systolic excursion (TAPSE), tricuspid annular pleak systolic velocity (TAPSV), and RV fractional area change were considered as an index of RV function. A strong relationship between TAPSE and TAPSV were found (r = 0.76). Thirty-day mortality was 10.8%. Five-year survival and possibility to be alive in NYHA classes I-II were 66.5 +/- 5.0 and 59.5 +/- 5.0%. TAPSE, TAPSV, and MV coaptation depth (MVCD) were found to be risk factors for worse early and mid-term outcome; functional class impaired mid-term outcome. ROC analysis identified TAPSE < or = 12 mm, TAPSV < or = 10 cm/s, and MVCD>10 mm as predictive cut-offs.


CONCLUSIONS
Pre-operative assessment of some echocardiographic parameters (TAPSE, TAPSV) is very easy, low cost, and provides accurate information on RV function. A good pre-operative clinical compensation has to be necessarily reached before the operation. MVCD should be evaluated to decide surgical strategy (repair or replace).
Di Mauro
Michele
M
Department of Cardiology, San Camillo Hospital, via Forlanini 50, University G D'Annunzio, 66100 Chieti, Italy.
Calafiore
Antonio Maria
AM
Penco
Maria
M
Romano
Silvio
S
Di Giammarco
Gabriele
G
Gallina
Sabina
S
D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000601:surgery*; D018572:Disease-Free Survival; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*