P117. Association Between Mitral Annular Anteroposterior Reduction and Postoperative Aortic Insufficiency
Suita
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Kazuma Handa, MD, is a board-certified cardiovascular and thoracic surgeon and PhD candidate at The University of Osaka Graduate School of Medicine. He clinically specializes in structural heart disease, coronary and aortic root surgery, and heart transplantation.
His basic research focuses on mRNA-based therapeutics for heart failure, including intracoronary delivery with lipid nanoparticles and polyplex nanomicelles, self-amplifying RNA, and multifactor mRNA therapy.
To date, Dr. Handa has published 18 peer-reviewed articles, secured Four competitive research grants, received 12 academic awards, and holds one patent. His surgical expertise has also been recognized with three awards for excellence in cardiovascular surgical techniques, including coronary artery anastomosis.
Dr. Handa aims to advance minimally invasive cardiovascular surgery, develop next-generation mRNA therapeutics, and foster international collaboration in translational cardiovascular medicine.
Description
The mitral valve is anatomically contiguous with the aortic valve through the aorto-mitral continuity. Excessive anteroposterior annular reduction during mitral valve surgery (MVS) may therefore affect aortic valve function. However, this interaction remains unknown. This study investigated the relationship between the mitral annular anteroposterior reduction rate and postoperative worsening of aortic insufficiency (AI) in MVS.
Methods:
Among 857 patients who underwent MVS between 2010 and 2022, those with concomitant or prior aortic valve surgery, infective endocarditis, or redo MVS (n=374) were excluded. Of the remaining 483 primary MVS cases, 245 patients (50.7%) with preoperative contrast-enhanced CT were analyzed. The mitral annular anteroposterior reduction rate (%) was calculated as: implanted prosthetic ring or valve anteroposterior diameter (mm) / preoperative native mitral annulus anteroposterior diameter (mm) × 100 (lower values indicate greater reduction) (Fig.A). Worsening AI was defined as (1) ≥1 grade increase or (2) unplanned aortic valve surgery for severe intraoperative AI.
Results:
Median age was 67 years [IQR 54–75], 66% were male, and mitral valve repair (MVr) was performed in 202 patients (82.4%), including 159 with full rings and 43 with partial rings. Mitral valve replacement (MVR) was performed in 43 patients (17.6%). Reduction rate was significantly lower in MVr than in MVR (88.2 [82.1–93.4]% vs. 95.2 [89.7–107.0]%, P<0.001; Fig.B). Postoperative worsening of AI occurred in 11.0%, including two patients requiring unplanned aortic valve replacement. In the MVR cohort, reduction rates did not differ between patients with and without worsening AI (97.8 [89.9–103.0]% vs. 94.5 [89.0–117.0]%, P>0.999; Fig.C). In the MVr cohort, reduction rates tended to be lower in patients with worsening AI (85.2 [75.4–92.2]% vs. 88.9 [82.8–93.8]%, P=0.077). In the partial ring subgroup, reduction rates were comparable (93.8 [90.1–97.1]% vs. 89.4 [83.2–96.4]%, P=0.259; Fig.D), whereas, in the full ring subgroup, worsening AI was associated with significantly lower reduction rates (81.6 [74.0–87.8]% vs. 88.1 [82.3–93.7]%, P=0.009; Fig.E).
Conclusions:
In primary MVS, excessive anteroposterior reduction of the mitral annulus, particularly with a full ring, was significantly associated with postoperative worsening of aortic insufficiency. Careful annular sizing is essential to avoid adverse aortic valve interactions.
Authors
Kazuma Handa (1), Shin Yajima (1), Yusuke Yanagino (1), Yumi Kakizawa (1), Daisuke Yoshioka (1), Takuji Kawamura (1), Ai Kawamura (1), Yusuke Misumi (1), Shunsuke Saito (1), Shigeru Miyagawa (1)
Institutions
(1) Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine, Suita, Osaka, Japan