Abstract 16475: Pre-Operative 3D Posterior Leaflet Mitral Measurements Can Differentiate Patients Needing Leaflet Resection in Degenerative Mitral Valve Repair Suergery
Background: Although nonresectional techniques for mitral valve (MV) repair are increasing, leaflet resection is still needed for some patients with excessive posterior leaflet tissue. We hypothesized that dynamic preoperative 3D-transoesophageal echocardiography (TEE) based 3D mitral annular and leaflet measurements can predict the need for leaflet resection in patients with degenerative MV (DMV) disease undergoing repair with an annuloplasty band and neochords.
Methods: Preoperative 3D-TEE full volume MV data were acquired (iE33 X-7t, Philips) in 37 patients (60±10 yrs; 26 male) with complex MV prolapse (3.0±1.7 segments/patient) undergoing repair surgery by expert MV surgeons. Semi-automated software (Siemens Medical Solutions) measured true 3D mitral annular and leaflet parameters at mid-systole. The surgeons were blinded to all 3D measurements.
Results: All patients received a mitral annuloplasty band and neochords (13±8 chords/patient) but only 15 (41%) required posterior leaflet resection. Early post-operative results were excellent with no significant stenosis or regurgitation in any patients. Patients treated with leaflet resection had significantly larger 3D annular circumference, P2 length, P2 area, and total posterior leaflet area (Table). A P2 length ≥21.0mm and P2 area ≥3.90cm2 were the best discriminators of the need for resection (ROC analysis, Figure).
Conclusion: In patients undergoing MV repair for DMV disease using an annuloplasty band and neochords, physiologic 3D TEE based measurements of P2 length and area can predict the additional need for leaflet resection. These measurements should be considered in MV surgical repair planning.
- © 2013 by American Heart Association, Inc.