title: Mitral valve gradient after valve repair of degenerative regurgitation with restrictive annuloplasty.
abstract: BACKGROUND
  Outcomes of mitral valve repair have been well described for patients with degenerative regurgitation. The hemodynamic effects of repair have not been as well studied, however. We report hemodynamic outcomes in these patients.
  
  
  METHODS
  We reviewed 1147 patients who underwent isolated mitral valve repair for degenerative mitral valve regurgitation between January 2004 and December 2013. Baseline characteristics included mean age 58.6 ± 13.4 years, male sex in 792 patients (69.1%), mean ejection fraction of 0.64 ± 0.07, and New York Heart Association class III/IV dyspnea in 215 patients (18.8%).
  
  
  RESULTS
  Mitral valve repair involved the posterior leaflet in 764 patients (66.6%), anterior leaflet in 57 patients (5.0%), both leaflets in 260 patients (22.7%), and annuloplasty alone in 66 patients (5.8%). Among the patients who underwent posterior leaflet repair, 713 (93.3%) were treated with our standard technique of triangular leaflet resection/plication and repair with partial posterior band annuloplasty using an unmeasured 63-mm flexible band. Follow-up echocardiography data were obtained in 1138 survivors (99.4%) at 600 ± 880 days. Mild or less valve regurgitation was present at last follow-up in 1030 patients (90.5%). The mean mitral valve gradient was 3.1 ± 1.4 mm Hg in the operating room and 3.5 ± 1.6 mm Hg at the last follow-up (P < .001). The mean mitral valve gradient decreased from the first to the second median time periods (124.5 days) of follow-up (3.7 ± 1.6 mm Hg to 3.3 ± 1.8 mm Hg; P < .001).
  
  
  CONCLUSIONS
  Mitral valve repair for degenerative regurgitation results in a small mitral valve gradient that appears to decrease with time after discharge.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Takashi
authors.initials: T
authors.lastname: Murashita
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn. Electronic address: greason.kevin@mayo.edu.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Greason
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Abu Dhabi, United Arab Emirates.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Lyle D
authors.initials: LD
authors.lastname: Joyce
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: John M
authors.initials: JM
authors.lastname: Stulak
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pochettino
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: David L
authors.initials: DL
authors.lastname: Joyce
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome
keywords: complication; gradient; heart; mitral valve; valve; valve repair