Abstract 11645: Early Mitral Valve Surgery in Chronic Mitral Valve Regurgitation is Favorable to Left Ventricular Mass Regression and Left Ventricular Performance in Ventricular Energetics
Background: The heads of left ventricular mass (LVM) and LV energetics is not included in the guidelines for the timing of mitral valve surgery (MVS) for severe mitral valve regurgitation (MR). We aimed to evaluate the change of LVM and LV performance using ventricular energetics after MVS between LV dysfunction (LVEF < 60% or LV end-systolic dimension ≥ 40mm) and non-LV dysfunction.
Methods: We reviewed the cases of consecutive 50 patients who had chronic asymptomatic degenerative MR and electively underwent isolated MVS (repair 36 and replacement 14) in our institute. End-systolic elastance (Ees), effective arterial elastance (Ea), ventricular efficiency (Ea/Ees and the ratio of stroke work to pressure-volume area (SW/PVA)), and LVM were non-invasively measured by transthoracic echocardiography. We analyzed the parameters in patients with (A group 17) and without (B group 33) LV dysfunction before and at 1 month after surgery.
Results: Ees did not change in either A group (1.2±0.3 to 1.5±0.7 mmHg•m2/ml) or B group (2.4±0.9 to 2.1±0.5 mmHg•m2/ml). Both Ea increased significantly after MVS (A: 1.4±0.6 to 2.0±0.6 mmHg•m2/ml, p<0.0001; B: 1.4±0.6 to 2.3±0.6 mmHg•m2/ml, p<0.0001). Consequently, ventricular efficiency (Ea/Ees and SW/PVA) deteriorated significantly after the surgery (A: 1.3±0.8 to 1.7±1.2, p<0.0001, and 64±11 to 58%±14%, p<0.0001; B: 0.6±0.2 to 1.1±0.3, p<0.0001, and 77±5 to 65%±7%, p<0.0001). LVM index in both groups described the significant decrease (A: 179±39 to 139±37 g/m2, p<0.0001; B: 153±40 to 104±23 g/m2, p<0.0001). On the other hand, early surgery in preserved LV function was associated with higher Ees, less worsen ventricular efficiency, and more mass regression (p<0.0001).
Conclusions: Performing MVS in preserved LV function is associated with a greater likelihood of remarkable regression of LVM, possibly predicting improved recovery of normal LV function after MVS. These data provide additional support for early surgical correction of chronic degenerative MR.
- © 2011 by American Heart Association, Inc.