Abstract 14131: Partial Band Annuloplasty Could Relieve Functional Mitral Stenosis Following Surgical Repair for Degenerative Mitral Regurgitation in Comparison With Complete Ring: Exercise Stress Echocardiographic Study
Introduction: Partial band (PB) mitral annuloplasty could better preserve anterior annulus physiological motion in comparison with complete ring (CR); thus, it might relieve functional mitral stenosis (MS) following mitral valve (MV) repair.
Objective: To validate the favorable effects of PB annuloplasy on MS following MV repair.
Methods: Symptom-limited bicycle exercise echocardiography was obtained in 53 patients who underwent MV repair for degenerative mitral regurgitation (MR) and had postoperatively residual MR <moderate degree. PB (CG Future band, Medtronic) was implanted in 26 patients and complete ring (CR, Carpentier-Edwards Physio or Physio II, Edwards) in 27. Trans-mitral flow mean gradient (MG) was calculated using continuous-wave Doppler, and body surface area-indexed mitral valve effective orifice area (EOAi) was obtained by dividing stroke volume (SV) measured at left ventricular outflow tract by trans-mitral flow time velocity integral.
Results: There was no significant difference between PB and CR in indexed geometric ring or band orifice area (ROAi, 3.06±0.50 vs. 3.04±0.74 cm2/m2) which was measured in vitro. Echocardiography at rest did not show any differences between two groups (MG: median 3.1 [IQR 2.0-4.1] vs. 3.6 [3.0-5.0] mmHg), indexed SV(SVi): 45 [43-54] vs. 48 [39-51] mL/m2, and EOAi: 1.2 [1.1-1.5] vs. 1.3 [1.0-1.5] cm2/m2; All P=NS). At peak exercise, maximal workload (100 [62-100] vs. 100 [75-100] ), MG (8.5 [5.8-12.4] vs. 11.5 [7.8-17.7] mmHg ), and SVi (56 [49-62] vs. 50 [47-61] mL/m2) did not differ (All P=NS). However, EOAi was significantly larger in PB than in CR at peak exercise (1.5 [1.3-1.7] vs. 1.3 [1.1-1.5] cm2/m2). In patients with ring or band of ROAi >2.98 cm2/m2 (median value; PB: N=13; CR: N=12), there was no difference in MG at peak exercise (7.2 [5.8-9.2] vs. 7.5 [5.8-8.5] mmHg, P=NS). Contrarily, in patients with ROAi <2.98cm2/m2, MG at peak exercise was less aggravated in PB than in CR (11.6 [7.0-15.5] vs. 13.6 [11.9-19.2] mmHg, P<0.05).
Conclusions: In patients in whom inappropriately small-sized prosthetic ring for their body structure must be implanted based on the anterior leaflet dimensions; PB annuloplasty might ameliorate exercise-induced functional MS after MV repair in comparison with CR.
Author Disclosures: T. Miki: None. T. Yamano: None. A. Otsuka: None. N. Wakana: None. M. Yamano: None. N. Nakanishi: None. S. Yamazaki: None. K. Zen: None. T. Nakamura: None. H. Shiraishi: None. K. Doi: None. T. Shirayama: None. H. Yaku: None. S. Matoba: None.
- © 2016 by American Heart Association, Inc.