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(Circulation. 2007;115:782-791.)
© 2007 American Heart Association, Inc.

Valvular Heart Disease

Preoperative Posterior Leaflet Angle Accurately Predicts Outcome After Restrictive Mitral Valve Annuloplasty for Ischemic Mitral Regurgitation

Julien Magne, MSc; Philippe Pibarot, DVM, PhD; François Dagenais, MD, FRCS; Zeineb Hachicha, MD; Jean G. Dumesnil, MD, FRCPC; Mario Sénéchal, MD, FRCPC

From the Quebec Heart Institute, Faculty of Medicine, Laval University, Quebec, Canada.

Correspondence to Dr Mario Sénéchal, Quebec Heart Institute, Department of Cardiology, 2725 Chemin Sainte-Foy, Quebec, Quebec, Canada, G1V 4G5. E-mail mario.senechal{at}crhl.ulaval.ca

Received July 5, 2006; accepted December 11, 2006.

Background— Ischemic mitral regurgitation (MR) often persists after restrictive mitral valve annuloplasty, in which case it is associated with worse clinical outcomes. The goal of the present study was to determine whether persistence of MR and/or clinical outcome could be predicted from preoperative analysis of mitral valve configuration.

Methods and Results— In 51 consecutive patients undergoing restrictive annuloplasty for ischemic MR, posterior leaflet (PL) angle, anterior leaflet angle, coaptation distance, and tenting area were quantified by echocardiography before surgery (6±3 days), and MR severity was assessed before and early after surgery (9±4 days). Postoperatively, persistence of mild to moderate MR (vena contracta >3 mm) was observed in 11 (22%) of the patients. The best predictor of postoperative persistence of MR was a PL angle 45 degrees (sensitivity 100%, specificity 97%, positive predictive value 92%, negative predictive value 100%). Patients with persistent MR had markedly lower 3-year event-free survival (26±20%) compared with those with nonpersistent MR (75±12%, P=0.01). Preoperative presence of a PL angle 45 degrees also was associated with a markedly lower 3-year event-free survival (22±17% versus 76±12%; P<0.001).

Conclusions— In patients undergoing restrictive annuloplasty for ischemic MR, persistence of MR and 3-year event-free survival can accurately be predicted by preoperative analysis of mitral valve configuration. Patients with a PL angle 45 degrees (ie, with high PL restriction) should thus be considered poor candidates for this procedure, and concomitant or alternative procedures should be contemplated.

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CLINICAL PERSPECTIVE

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