Abstract 2703: Persistence and Outcomes of Ischemic Mitral Regurgitation
Objective: Previous studies have demonstrated that ischemic mitral regurgitation (MR) often persists or recurs after restrictive mitral valve annuloplasty (MVA) and adversely affects patient’s outcome. We hypothesized that persistent ischemic MR can be predicted by the preoperative echocardiographic assessment of mitral valve configuration.
Method and Results: In 51 patients undergoing restrictive annuloplasty for ischemic MR, posterior leaflet (PL) angle, anterior leaflet angle, coaptation distance, tenting area and MR severity were quantified by echocardiography before and early after surgery (9+/-4 days). Eleven (22%) of the 51 patients had persistent mild to moderate MR (vena contracta > 3mm) after annuloplasty. The preoperative presence of a PL angle ≤ 45° predicted the postoperative persistence of MR with as sensitivity of 100%, a specificity of 97%, a positive predictive value 92%, and a negative predictive value of 100%. Patients with persistent MR had markedly lower 3-years event-free survival (26+/-20%) compared to those with non persistent MR (75+/-12%; p=0,01). The presence of a PL angle ≥ 45° before operation was associated with significantly lower 3-years event-free survival (27+/-20% vs 74+/-12%; p=0,016).
Conclusion: The results of this study show that the postoperative outcome and persistence of ischemic MR can be predicted from the preoperative configuration of the mitral valve. Patients with a preoperative PL angle ≥ 45° are at very high risk for MR persistence and worse outcome, when treated by annuloplasty and CABG. In these patients, concomitant or alternative procedures should be considered.