MO66. The Impact of Preoperative Left Ventricular Systolic Dysfunction on Reverse Remodelling Following Mitral Repair: Insights from CAMRA CardioLink-2 Randomized Trial
Presented During: Mini-Orals: Translational Research, Innovation, Predictive Modeling
Cleveland Clinic
Cleveland Heights, OH
United States - Contact Me
Makoto Hibino, MD MPH PhD FACS FACC
Division of Cardiothoracic Surgery, Department of Surgery,
Cleveland Clinic, Cleveland, OH, USA
Four times awardee in the OPCAB anastomosis contests. Early graduation award in PhD. Young Investigator Award Winner in AHA 2021.
Primary clinical interests include Minimally invasive cardiac surgery, Valvular surgery, Aortic surgery, TAVI, Endovascular aortic procedures.
Primary research interests include epidemiological research, big-data analysis, cohort study, randomized control trial.
Friday, May 5, 2023: 7:50 AM - 7:55 AM
5 Minutes
New York Hilton Midtown
Room: Petit Trianon
Description
Objective: The ideal time to undergo mitral repair surgery for degenerative mitral regurgitation is before patients develop systolic dysfunction defined as LVEF ≤60% or LVESD ≥40 mm. We studied the impact of systolic dysfunction on the LV reverse remodeling in the sub-analysis of The Canadian Mitral Research Alliance CardioLink-2 study, a randomized trial comparing leaflet resection versus preservation techniques for posterior leaflet prolapse.
Methods: A total of 74 patients were included in the analysis and divided into 2 groups, those with or without preoperative systolic dysfunction. We compared changes in echocardiography up to 12 months postoperatively.
Results: Systolic dysfunction was identified in 35 participants. Patient characteristics were not significantly different except for higher prevalence of atrial fibrillation in those with systolic dysfunction (17 (49%), vs. 6 (15%), p=0.003). At baseline, those with systolic dysfunction had significantly larger mean LV geometry (57.4mm, 39.9mm, 194.3ml, and 81.0ml vs. 52.2mm, 32.0mm, 162.2ml, and 58.6ml in LVEDD, LVESD, LVEDV, and LVESV, respectively). This association was unchanged before discharge and at 12 months (50.4mm, 35.5mm, 140.8ml, and 63.7ml vs. 46.4mm, 32.5mm, 120.3ml, and 51.4ml, respectively at 12 months); however, those with systolic dysfunction had better (-1.8mm vs +2.1mm, p<0.001 in mean LVESD change) or equivalent (-4.9mm and -38.8ml vs -2.9mm and -31.2ml, p=0.061 and 0.37 in mean LVEDD and LVEDV change) reverse remodeling in acute phase (before discharge vs baseline). In mid-term phase (12 months vs before discharge), those with systolic dysfunction had significant reverse remodeling which was equivalent to those without systolic dysfunction (-2.4mm, -2.8mm and -13.2ml vs -2.9mm, -1.7mm and -12.0ml, p=0.71, p=0.43 and 0.83 in mean LVEDD, LVESD and LVESV change). Those with systolic dysfunction had lower LVEF at baseline (57.7% vs 64.1%, p<0.001), before discharge (48.1% vs 53.5%, p=0.013) and at 12 months (55.1% vs 57.6%, p=0.045) but had significant recovery in mid-term phase which was equivalent to those without systolic dysfunction (4.1% vs 4.5%, p=0.84).
Conclusions: Those with preoperative systolic dysfunction had greater LV dimensions and volumes and lower LVEF postoperatively than those without systolic dysfunction; however, both the groups had similar reverse remodeling both in acute and mid-term phase. Further study is warranted to investigate long-term trends.
Methods: A total of 74 patients were included in the analysis and divided into 2 groups, those with or without preoperative systolic dysfunction. We compared changes in echocardiography up to 12 months postoperatively.
Results: Systolic dysfunction was identified in 35 participants. Patient characteristics were not significantly different except for higher prevalence of atrial fibrillation in those with systolic dysfunction (17 (49%), vs. 6 (15%), p=0.003). At baseline, those with systolic dysfunction had significantly larger mean LV geometry (57.4mm, 39.9mm, 194.3ml, and 81.0ml vs. 52.2mm, 32.0mm, 162.2ml, and 58.6ml in LVEDD, LVESD, LVEDV, and LVESV, respectively). This association was unchanged before discharge and at 12 months (50.4mm, 35.5mm, 140.8ml, and 63.7ml vs. 46.4mm, 32.5mm, 120.3ml, and 51.4ml, respectively at 12 months); however, those with systolic dysfunction had better (-1.8mm vs +2.1mm, p<0.001 in mean LVESD change) or equivalent (-4.9mm and -38.8ml vs -2.9mm and -31.2ml, p=0.061 and 0.37 in mean LVEDD and LVEDV change) reverse remodeling in acute phase (before discharge vs baseline). In mid-term phase (12 months vs before discharge), those with systolic dysfunction had significant reverse remodeling which was equivalent to those without systolic dysfunction (-2.4mm, -2.8mm and -13.2ml vs -2.9mm, -1.7mm and -12.0ml, p=0.71, p=0.43 and 0.83 in mean LVEDD, LVESD and LVESV change). Those with systolic dysfunction had lower LVEF at baseline (57.7% vs 64.1%, p<0.001), before discharge (48.1% vs 53.5%, p=0.013) and at 12 months (55.1% vs 57.6%, p=0.045) but had significant recovery in mid-term phase which was equivalent to those without systolic dysfunction (4.1% vs 4.5%, p=0.84).
Conclusions: Those with preoperative systolic dysfunction had greater LV dimensions and volumes and lower LVEF postoperatively than those without systolic dysfunction; however, both the groups had similar reverse remodeling both in acute and mid-term phase. Further study is warranted to investigate long-term trends.
Presentation Duration
3-minute presentation; 2-minute discussion