Postoperative recurrence of mitral regurgitation after annuloplasty for functional mitral regurgitation.
BACKGROUND
We investigated predictive factors of postoperative recurrence of mitral regurgitation (MR) after mitral valve annuloplasty for functional ischemic MR.


METHODS
This study was a retrospective review of patients with functional MR who underwent mitral ring annuloplasty at our institution from 1998 to 2008. Records were reviewed for perioperative variables, including echocardiographic measurements. Recurrence was defined as MR grade moderate (3+) or greater on any postoperative echocardiogram.


RESULTS
Of 548 patients who underwent mitral annuloplasty for functional MR, echocardiogram reports were available for review for 250. These patients comprised the study cohort. There were 154 patients with concomitant coronary artery bypass grafting. The left ventricular (LV) end-diastolic (LVED) index was calculated by dividing the LVED dimension by body surface area (BSA). A high LVED index (>3.5 cm/m2) was predictive of MR recurrence (p=0.047): the recurrence rate was 20.3% (13 of 64) in high-index patients and 10.2% (19 of 186) in low-index (<3.5 cm/m2) patients. Median recurrence-free survival was 35 months (range, 19 to 59 months) in high-LVED-index patients and 46.5 months (range, 22 to 75 months) in low-LVED-index patients (p=0.048). Preoperative MR severity and LV ejection fraction were not predictive of MR recurrence.


CONCLUSIONS
Careful analysis of the preoperative echocardiogram using a novel, easily calculated variable, the LVED index, may help identify patients who are at greater risk for MR recurrence and reduced survival. Such information could prompt consideration of alternative or additional interventions in these patients.
Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Lawrence S
LS
Lee
Michael H
MH
Kwon
Marisa
M
Cevasco
Jan D
JD
Schmitto
Suyog A
SA
Mokashi
Siobhan
S
McGurk
Lawrence H
LH
Cohn
R Morton
RM
Bolman
Frederick Y
FY
Chen
D000368:Aged; D058385:Cardiac Valve Annuloplasty / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications* / Q000503:physiopathology; D011184:Postoperative Period; D011379:Prognosis; D011475:Prosthesis Failure; D012008:Recurrence; D012189:Retrospective Studies; D016277:Ventricular Function, Left