MO63. Predictive Geometric Analysis of Mitral Valve for Recurrence of Mitral Regurgitation after Mitral Annuloplasty in Patients with Atrial Functional Mitral Regurgitation
Presented During: Mini-Orals: Translational Research, Innovation, Predictive Modeling
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I am a cardiothoracic surgeon experienced various cardiovascular surgery in the Department of Cardiothoracic Surgery at Osaka University School of Medicine in Japan. I performed aortic valve surgery, mitral valve surgery, coronary artery bypass graft, thoracic aorta replacement and abdominal aorta replacement.
My clinical focus is the surgical treatment for severe heart failure, including mechanical circulatory support, for example left ventricular assist device and extracorporeal membrane oxygenation (ECMO). I have studied the effect of long term unloading for left ventricular in large animal model of acute myocardial infarction.
Friday, May 5, 2023: 7:35 AM - 7:40 AM
5 Minutes
New York Hilton Midtown
Room: Petit Trianon
Description
Objective: Recent studies reveal precise recognition and increased prevalence of atrial functional mitral regurgitation (AFMR). However, the mechanism of AFMR is not fully addressed, and appropriate surgical intervention is still unknown. We herein reviewed patients with AFMR underwent mitral annuloplasty (MAP) in our institution and investigated preoperative geometric characters of the mitral valve in terms of recurrence of MR after surgery.
Method: We retrospectively reviewed 20 patients with AFMR underwent mitral valve surgery from 2010 to 2022 (median age: 75±7 years, male: 30%). Mean follow-up period was 3.2±2.3years. Preoperative three-dimensional transesophageal echocardiogram (3D TEE) was available in all patients and geometric analysis of the mitral valve was performed by software of the Philips Q-Lab.
Result: All patients survived during the follow-up period. MAP was performed in all patients, anterior mitral leaflet chordal reconstruction using artificial chordae in 2 patients, and patch augmentation of mitral posterior leaflet in 1 patient. Freedom rate from recurrent of MR was 79% and 57% at 1year and 3 years, respectively. Recurrent MR occurred in 6 patients and the causes were recurrent of functional MR in 4 patients and detachment of MAP ring in 2 patients. Preoperative 3D TEE examination revealed that patients with recurrent MR had longer circumstance of mitral annulus and larger area of posterior mitral leaflet (PML) than patients without recurrent MR (circumstance of mitral annulus; 137±11 vs. 124±12 mm, p = 0.02, PML area; 797±231 vs. 552±144 mm2 p = 0.01). Especially, lateral side of PML in patients with recurrent MR was longer than those in patients without recurrent MR (P1; 15±5 vs.10±3 mm, p＜0.01, P2; 14±4 vs.11±4 mm, p =0.23, P3; 10±3 vs.8±3 mm, p =0.13).
Conclusion: AFMR patients with longer circumstance of mitral annulus, larger PML area, and asymmetric PML remodeling tended to recur MR after MAP. Those factors in the mitral valve could indicated progressed remodeling and advanced disease stage of AFMR, and MAP only might not be sufficient for those patients.
Method: We retrospectively reviewed 20 patients with AFMR underwent mitral valve surgery from 2010 to 2022 (median age: 75±7 years, male: 30%). Mean follow-up period was 3.2±2.3years. Preoperative three-dimensional transesophageal echocardiogram (3D TEE) was available in all patients and geometric analysis of the mitral valve was performed by software of the Philips Q-Lab.
Result: All patients survived during the follow-up period. MAP was performed in all patients, anterior mitral leaflet chordal reconstruction using artificial chordae in 2 patients, and patch augmentation of mitral posterior leaflet in 1 patient. Freedom rate from recurrent of MR was 79% and 57% at 1year and 3 years, respectively. Recurrent MR occurred in 6 patients and the causes were recurrent of functional MR in 4 patients and detachment of MAP ring in 2 patients. Preoperative 3D TEE examination revealed that patients with recurrent MR had longer circumstance of mitral annulus and larger area of posterior mitral leaflet (PML) than patients without recurrent MR (circumstance of mitral annulus; 137±11 vs. 124±12 mm, p = 0.02, PML area; 797±231 vs. 552±144 mm2 p = 0.01). Especially, lateral side of PML in patients with recurrent MR was longer than those in patients without recurrent MR (P1; 15±5 vs.10±3 mm, p＜0.01, P2; 14±4 vs.11±4 mm, p =0.23, P3; 10±3 vs.8±3 mm, p =0.13).
Conclusion: AFMR patients with longer circumstance of mitral annulus, larger PML area, and asymmetric PML remodeling tended to recur MR after MAP. Those factors in the mitral valve could indicated progressed remodeling and advanced disease stage of AFMR, and MAP only might not be sufficient for those patients.
Presentation Duration
3-minute presentation; 2-minute discussion