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The Journal of Cardiovascular Surgery 2021 May 31

DOI: 10.23736/S0021-9509.21.11843-9


lingua: Inglese

Left Ventricular remodeling after Mitral Valve repair and Papillary Muscle Approximation

Priscilla WESSLY 1, Denisse DIAZ 1, Rafle FERNANDEZ 1, Mark J. LARRALDE 1, Sofia A. HORVATH 1, Steve XYDAS 2, Christos G. MIHOS 1

1 Echocardiography Laboratory, Division of Cardiology, Columbia University, Miami Beach, FL, USA; 2 Division of Cardiac Surgery, Mount Sinai Heart Institute, Columbia University, Miami Beach, FL, USA


BACKGROUND: Mitral valve repair with papillary muscle approximation (MVr-PMA) for severe secondary mitral regurgitation (MR) decreases MR recurrence compared with MVr alone. This study assessed the effects of MVr-PMA on left ventricular (LV) remodeling and shape, systolic function and strain mechanics.
METHODS: Forty-eight patients who underwent MVr-PMA for severe secondary MR and had follow-up echocardiograms available for review were identified. Student’s t-test, linear regression modeling, and receiver-operating characteristic curves were used in the statistical analyses.
RESULTS: Median follow-up time was 14.9 months. MVr-PMA was associated with significant LV reverse remodeling with a smaller LV end-diastolic diameter, systolic sphericity index, and interpapillary muscle distance at follow-up. Nine patients (18.8%) experienced ≥ moderate recurrent MR. When compared recurrent MR patients at follow-up, those with durable MVr-PMA had a greater LV ejection fraction (32.8 vs 22.0%, p=0.03), a smaller end-diastolic diameter (59.6 vs 67.3 mm, p=0.03), systolic sphericity index (0.35 vs 0.47, p=0.03), and endsystolic interpapillary muscle distance (16.3 vs 21.1 mm, p=0.03). A durable MVr-PMA also resulted in stable global longitudinal strain when compared with pre-operative values, while the recurrent MR group experienced a further decline (no recurrent MR: -8.4 vs -7.5%; recurrent MR: -8.2 vs -5.4%; p<0.05). A pre-operative LV end-diastolic diameter ≥ 64 mm was a discriminative predictor of MR recurrence (sensitivity = 100%, specificity = 51%, AUC = 0.756, p = 0.02).
CONCLUSIONS: A durable MVr-PMA confers improved LV geometry and function, and stable LV mechanics. The extent of baseline LV remodeling identifies patients at risk for recurrent MR.

KEY WORDS: Functional mitral regurgitation; Heart failure; Mitral regurgitation; Mitral valve repair; Secondary mitral regurgitation

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