Preoperative Left Ventricular End-diastolic Diameter and Its Postoperative Reduction Influence Early Outcomes of Mitral Valvuloplasty for Degenerative Mitral Regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIURuo-fan ,  XUJian-ping , SHIYi , ZHANGJia-hui , LIUShen

Department of Adult Cardiac Surgery, Fu Wai Hospital, Chinese Academy of Medical Sciences ﹠ Peking Union Medical College, Beijing 100037, P. R. China;

Corresponding author：

XUJian-ping, Email: jianpingxu@263.net

Keywords：

Mitral valvuloplasty; Left ventricular end-diastolic diameter; Risk factor

DOI：

10.7507/1007-4848.20140094

Video：

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Objective To analyze risk factors of early outcomes of mitral valvuloplasty (MVP)for the treatment of degenerative mitral regurgitation (DMR). Methods Clinical data of 132 DMR patients who underwent MVP in Fu Wai Hospital between January 1, 2011 and November 1, 2011 were retrospectively analyzed. A total of 114 patients (86.4%)were followed up after discharge with their mean age of 51.21±12.78 years, including 76 males (66.7%). Preoperative risk factors of early outcomes of MVP were analyzed. Results Among those patients, there were 25 patients with atrial fibri-llation (AF)(21.9%). Preoperative ejection fraction was 63.88%±6.93%. Preoperative echocardiography showed left ventricular end-diastolic diameter (LVEDD)was 31.61±5.51 mm/m². There were 66 patients (57.9%)with tricuspid regurg-itation, and 34 patients (29.8%)underwent concomitant tricuspid valvuloplasty including 10 patients (8.8%)who received tricuspid annuloplasty rings. Two patients died postoperatively, 2 patients underwent re-operation of mitral valve replacement or MVP respectively. Postoperative echocardiography showed moderate or severe mitral regurgitation in 15 patients. Preoperative risk factors of early outcomes of MVP included AF (36.8% vs. 18.9%, P=0.035), large LVEDD (34.02±3.76 mm/m² vs. 31.15±5.68 mm/m², P=0.042)and functional mitral regurgitation (15.8% vs. 1.1%, P=0.007). Multivariate analysis showed greater postoperative LVEDD reduction significantly lowered the incidence of postoperative events (HR 0.002, 95% CI < 0.001-0.570, P=0.031). Conclusions Enlargement of the left ventricle is an independent preoperative risk factor for early outcomes of MVP for DMR patients. Greater postoperative LVEDD reduction significantly lowers the incidence of postoperative events.

Citation： LIURuo-fan, XUJian-ping, SHIYi, ZHANGJia-hui, LIUShen. Preoperative Left Ventricular End-diastolic Diameter and Its Postoperative Reduction Influence Early Outcomes of Mitral Valvuloplasty for Degenerative Mitral Regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(3): 344-347. doi: 10.7507/1007-4848.20140094 Copy

1.	Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet, 2009, 373 (9672):1382-1394.
2.	Adams DH, Rosenhek R, Falk V. Degenerative mitral valve regurgitation:Best practice revolution. Eur Heart J, 2010, 31 (16):1958-1966.
3.	Gammie JS, Bartlett ST, Griffith BP. Small-incision mitral valve repair:Safe, durable, and approaching perfection. Ann Surg, 2009, 250 (3):409-415.
4.	Gillinov AM, Faber C, Houghtaling PL, et al. Repair versus replac-ement for degenerative mitral valve disease with coexisting ischemic heart disease. J Thorac Cardiovasc Surg, 2003, 125 (6):1350-1362.
5.	Seeburger J, Borger MA, Falk V, et al. Minimal invasive mitral valve repair for mitral regurgitation:Results of 1339 consecutive patients. Eur J Cardiothorac Surg, 2008, 34 (4):760-765.
6.	张卫, 郭震, 叶伟.二尖瓣成形术的临床应用及疗效分析.中国胸心血管外科临床杂志, 2010, 17(6):503-505.
7.	Suri RM, Schaff HV, Dearani JA, et al. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg, 2006, 82 (3):819-826.
8.	Flameng W, Meuris B, Herijgers P, et al. Durability of mitral valve repair in barlow disease versus fibroelastic deficiency. J Thorac Cardiovasc Surg, 2008, 135 (2):274-282.
9.	Yau TM, El-Ghoneimi YA, Armstrong S, et al. Mitral valve repair and replacement for rheumatic disease. J Heart Valve Dis, 2013, 22 (3):333-339.
10.	Gillinov AM, Blackstone EH, Nowicki ER, et al. Valve repair versus valve replacement for degenerative mitral valve disease. J Thorac Cardiovasc Surg, 2008, 135 (4):885-893.
11.	Kim JB, Kim HJ, Moon DH, et al. Long-term outcomes after surgery for rheumatic mitral valve disease:Valve repair versus mechanical valve replacement. Eur J Cardiothorac Surg, 2010, 37 (5):1039-1046.
12.	Mascherbauer J, Fuchs C, Pernicka E, et al. Predictors of outcome of non-ischemic mitral valve surgery. Int J Cardiol, 2013, 165 (1):87-92.
13.	Craver JM, Cohen C, Weintraub WS. Case-matched comparison of mitral valve replacement and repair. Ann Thorac Surg, 1990, 49 (6):964-969.
14.	Witkowski TG, Thomas JD, Debonnaire PJ, et al. Global longitu-dinal strain predicts left ventricular dysfunction after mitral valve repair. Eur Heart J Cardiovasc Imaging, 2013, 14 (1):69-76.
15.	Murashita T, Okada Y, Fujiwara H, et al. Mechanism of and risk factors for reoperation after mitral valve repair for degenerative mitral regurgitation. Circ J. 2013, 77 (8):2050-2055.
16.	Matsumura T, Ohtaki E, Tanaka K, et al. Echocardiographic predi-ction of left ventricular dysfunction after mitral valve repair for mitral regurgitation as an indicator to decide the optimal timing of repair. J Am Coll Cardiol, 2003, 42 (3):458-463.
17.	Kwon MH, Lee LS, Cevasco M, et al. Recurrence of mitral regurgitation after partial versus complete mitral valve ring annuloplasty for functional mitral regurgitation. J Thorac Cardiovasc Surg, 2013, 146 (3):616-622.
18.	Shimokawa T, Kasegawa H, Katayama Y, et al. Mechanisms of recurrent regurgitation after valve repair for prolapsed mitral valve disease. Ann Thorac Surg, 2011, 91 (5):1438-1439.
19.	Bernal JM, Ponton A, Diaz B, et al. Combined mitral and tricuspid valve repair in rheumatic valve disease:Fewer reoperations with prosthetic ring annuloplasty. Circulation, 2010, 121 (17):1934-1940.
20.	DiBardino DJ, ElBardissi AW, McClure RS, et al. Four decades of experience with mitral valve repair:Analysis of differential indications, technical evolution, and long-term outcome. J Thorac Cardiovasc Surg, 2010, 139 (1):76-83.
21.	Singh RG, Cappucci R, Kramer-Fox R, et al. Severe mitral regurgitation due to mitral valve prolapse:Risk factors for development, progression, and need for mitral valve surgery. Am J Cardiol, 2000, 85 (2):193-198.

1. Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet, 2009, 373 (9672):1382-1394.
2. Adams DH, Rosenhek R, Falk V. Degenerative mitral valve regurgitation:Best practice revolution. Eur Heart J, 2010, 31 (16):1958-1966.
3. Gammie JS, Bartlett ST, Griffith BP. Small-incision mitral valve repair:Safe, durable, and approaching perfection. Ann Surg, 2009, 250 (3):409-415.
4. Gillinov AM, Faber C, Houghtaling PL, et al. Repair versus replac-ement for degenerative mitral valve disease with coexisting ischemic heart disease. J Thorac Cardiovasc Surg, 2003, 125 (6):1350-1362.
5. Seeburger J, Borger MA, Falk V, et al. Minimal invasive mitral valve repair for mitral regurgitation:Results of 1339 consecutive patients. Eur J Cardiothorac Surg, 2008, 34 (4):760-765.
6. 张卫, 郭震, 叶伟.二尖瓣成形术的临床应用及疗效分析.中国胸心血管外科临床杂志, 2010, 17(6):503-505.
7. Suri RM, Schaff HV, Dearani JA, et al. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg, 2006, 82 (3):819-826.
8. Flameng W, Meuris B, Herijgers P, et al. Durability of mitral valve repair in barlow disease versus fibroelastic deficiency. J Thorac Cardiovasc Surg, 2008, 135 (2):274-282.
9. Yau TM, El-Ghoneimi YA, Armstrong S, et al. Mitral valve repair and replacement for rheumatic disease. J Heart Valve Dis, 2013, 22 (3):333-339.
10. Gillinov AM, Blackstone EH, Nowicki ER, et al. Valve repair versus valve replacement for degenerative mitral valve disease. J Thorac Cardiovasc Surg, 2008, 135 (4):885-893.
11. Kim JB, Kim HJ, Moon DH, et al. Long-term outcomes after surgery for rheumatic mitral valve disease:Valve repair versus mechanical valve replacement. Eur J Cardiothorac Surg, 2010, 37 (5):1039-1046.
12. Mascherbauer J, Fuchs C, Pernicka E, et al. Predictors of outcome of non-ischemic mitral valve surgery. Int J Cardiol, 2013, 165 (1):87-92.
13. Craver JM, Cohen C, Weintraub WS. Case-matched comparison of mitral valve replacement and repair. Ann Thorac Surg, 1990, 49 (6):964-969.
14. Witkowski TG, Thomas JD, Debonnaire PJ, et al. Global longitu-dinal strain predicts left ventricular dysfunction after mitral valve repair. Eur Heart J Cardiovasc Imaging, 2013, 14 (1):69-76.
15. Murashita T, Okada Y, Fujiwara H, et al. Mechanism of and risk factors for reoperation after mitral valve repair for degenerative mitral regurgitation. Circ J. 2013, 77 (8):2050-2055.
16. Matsumura T, Ohtaki E, Tanaka K, et al. Echocardiographic predi-ction of left ventricular dysfunction after mitral valve repair for mitral regurgitation as an indicator to decide the optimal timing of repair. J Am Coll Cardiol, 2003, 42 (3):458-463.
17. Kwon MH, Lee LS, Cevasco M, et al. Recurrence of mitral regurgitation after partial versus complete mitral valve ring annuloplasty for functional mitral regurgitation. J Thorac Cardiovasc Surg, 2013, 146 (3):616-622.
18. Shimokawa T, Kasegawa H, Katayama Y, et al. Mechanisms of recurrent regurgitation after valve repair for prolapsed mitral valve disease. Ann Thorac Surg, 2011, 91 (5):1438-1439.
19. Bernal JM, Ponton A, Diaz B, et al. Combined mitral and tricuspid valve repair in rheumatic valve disease:Fewer reoperations with prosthetic ring annuloplasty. Circulation, 2010, 121 (17):1934-1940.
20. DiBardino DJ, ElBardissi AW, McClure RS, et al. Four decades of experience with mitral valve repair:Analysis of differential indications, technical evolution, and long-term outcome. J Thorac Cardiovasc Surg, 2010, 139 (1):76-83.
21. Singh RG, Cappucci R, Kramer-Fox R, et al. Severe mitral regurgitation due to mitral valve prolapse:Risk factors for development, progression, and need for mitral valve surgery. Am J Cardiol, 2000, 85 (2):193-198.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Preoperative Left Ventricular End-diastolic Diameter and Its Postoperative Reduction Influence Early Outcomes of Mitral Valvuloplasty for Degenerative Mitral Regurgitation

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