Abstract 4288: Echocardiographic Predictor for Persistent Functional/Ischemic Mitral Regurgitation After Aortic Valve Replacement in Patients With Aortic Valve Stenosis
Background: Moderate functional/ischemic mitral regurgitation (MR) in patients with aortic valve stenosis (AS) is often left unaddressed at the time of aortic valve replacement (AVR) because it is expected to improve after AVR. However, some patients have persistent moderate MR after AVR. The purpose of this study was to determine the preoperative echocardiographic predictor for persistent functional/ischemic MR after AVR.
Methods: Pre and postoperative (mean 5±3 days) echocardiograms were reviewed in 110 patients with severe AS (mean aortic valve area: 0.67±0.17cm2) and functional/ischemic MR (grade ≥2+), who underwent AVR without mitral valve (MV) surgery. Fifty-eight patients received concomitant coronary artery bypass graft surgery. Functional/ischemic MR was defined as MR without morphological abnormalities of the mitral apparatus. The left ventricular (LV) volumes and ejection fraction (EF) were measured by the Simpson method. The severity of MR was assessed by using the ratio of the maximal MR jet area to left atrial area. In patients with MV tenting– defined as apical displacement of mitral leaflets in apical 4-chamber view– MV tenting area and tenting height were measured at mid-systole.
Results: Eighty patients had MV tenting and 30 did not have it before AVR. Patients with MV tenting had significantly more concomitant coronary artery disease, larger LV volumes and mass, lower EF, larger left atrial size, and more severe MR than those without MV tenting (all, P<0.05). MR severity in 51 of 80 (64 %) patients improved after AVR in patients with MV tenting vs. 25 of 30 (83 %) patients without MV tenting. Multivariate analysis revealed that the presence of chronic atrial fibrillation, preoperative MR severity and MV tenting area were independent predictors of postoperative MR severity in patients with MV tenting (all, P<0.05). The sensitivity and specificity in predicting persistent moderate MR after AVR were 72% and 82% for MV tenting area >1.4cm2, and 79% and 75% for tenting height >0.7cm, respectively.
Conclusions: Preoperative MV tenting predicts persistent functional/ischemic MR after AVR in patients with severe AS. MV repair is strongly recommended at the time of AVR in patients with significant functional/ischemic MR and severe MV tenting.