title: Mitral valve geometry and hemodynamics after surgical mitral valve annuloplasty and implications for percutaneous treatment of patients with recurrent mitral regurgitation.
abstract: 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 mm², 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.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Ibtihal
authors.initials: I
authors.lastname: Al Amri
authors.forename: Philippe
authors.initials: P
authors.lastname: Debonnaire
authors.forename: Tomasz
authors.initials: T
authors.lastname: Witkowski
authors.forename: Frank
authors.initials: F
authors.lastname: van der Kley
authors.forename: Meindert
authors.initials: M
authors.lastname: Palmen
authors.forename: Arend
authors.initials: A
authors.lastname: de Weger
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Klautz
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Nina
authors.initials: N
authors.lastname: Ajmone Marsan
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation