Abstract 17213: Does Left Ventricular - Mitral Ring Mismatch Predict Risk of Recurrent Mitral Regurgitation Post Annuloplasty in Patients With Ischemic Mitral Regurgitation?
Background: In ischemic mitral regurgitation (IMR), ring annuloplasty is associated with a 30-50% rate of recurrent IMR. Ring size is based on inter-trigonal distance without consideration of LV size. However, LV size is an important determinant of mitral valve (MV) leaflet tethering pre and post repair. We aimed to determine if LV - MV ring mismatch (mismatch of LV size relative to ring size) is associated with recurrent IMR in patients post ring.
Methods: Patients with moderate or severe IMR from the two cardiothoracic surgical network IMR trials (NCT-00806988 and 00807040) who received MV repair were examined at 1-year post-surgery. Baseline LV size was assessed by LV end-diastolic (LVIDed) and end-systolic (LVIDes) dimensions. LV- MV ring mismatch was calculated by dividing LV size by ring size (LVIDed/ring and LVIDes/ring). Multivariable regression models for each of these measures adjusting for age, sex, baseline LVEF and severe IMR were used to determine association with recurrent (≥moderate) IMR at one year.
Results: 1-year post ring, 45 (21%) of 216 repair patients had ≥moderate IMR. In univariate analysis, larger LVIDes (p=0.02) and higher LVIDes/ring (p=0.006) were associated with recurrent IMR; LVIDed and LVIDed/ring was not (p>0.05). In multivariable models both LVIDes/ring (p=0.01) and LVIDes (p=0.02) remained significantly associated with 1-year IMR recurrence; the odds of recurrence increasing by a relative 72% per 10% increase in LVIDes/ring and by 70% per 10mm increase in LVIDes.
Conclusion: We found that increasing LV-MV ring mismatch and LVIDes are both associated with increased risk of IMR recurrence. The high correlation between LVIDes and LVIDes/ring in our data precludes a definitive determination of the relative contribution of each measure to the increased risk of IMR recurrence. While further research is needed to confirm our findings, these data may be helpful in guiding ring size to prevent recurrent IMR in patients undergoing MV repair.
Author Disclosures: R. Capoulade: None. X. Zeng: None. J.R. Overbey: None. G. Ailawadi: Consultant/Advisory Board; Modest; Abbott Vascular, Edwards, Atricure, St. Jude. J. Alexander: None. D. Ascheim: Consultant/Advisory Board; Modest; Celladon Corp.. M. Bowdish: None. A. Gelijns: None. P. Grayburn: Research Grant; Significant; Abbott Vascular, Edwards Lifesciences, Medtronic, Boston Scientific, Tendyne. Other Research Support; Significant; Valtech Cardio, Tendyne. Consultant/Advisory Board; Modest; Abbott Vascular, Tendyne, Bracco Diagnostics. I. Kron: None. M. Mack: Consultant/Advisory Board; Modest; Edwards Lifesciences, Abbott Vascular. S. Melnichouk: None. R. Michler: None. J. Mullen: None. P. O'Gara: None. M. Parides: None. P.K. Smith: None. P. Voisine: None. J. Hung: None.
- © 2015 by American Heart Association, Inc.