Tags

Type your tag names separated by a space and hit enter

Intraoperative post-annuloplasty three-dimensional valve analysis does not predict recurrent ischemic mitral regurgitation.
J Cardiothorac Surg. 2020 Jul 02; 15(1):161.JC

Abstract

BACKGROUND

High ischemic mitral regurgitation (IMR) recurrence rates continue to plague IMR repair with undersized ring annuloplasty. We have previously shown that pre-repair three-dimensional echocardiography (3DE) analysis is highly predictive of IMR recurrence. The objective of this study was to determine the quantitative change in 3DE annular and leaflet tethering parameters immediately after repair and to determine if intraoperative post-repair 3DE parameters would be able to predict IMR recurrence 6 months after repair.

METHODS

Intraoperative pre- and post-repair transesophageal real-time 3DE was performed in 35 patients undergoing undersized ring annuloplasty for IMR. An advanced modeling algorhythm was used to assess 3D annular geometry and regional leaflet tethering. IMR recurrence (≥ grade 2) was assessed with transthoracic echocardiography 6 months after repair.

RESULTS

Annuloplasty significantly reduced septolateral diameter, commissural width, annular area, and tethering volume and significantly increased all segmental tethering angles (except A2). Intraoperative post-repair annular geometry and leaflet tethering did not differ significantly between patients with recurrent IMR (n = 9) and patients with non-recurrent IMR (n = 26). No intraoperative post-repair predictors of IMR recurrence could be identified.

CONCLUSIONS

Undersized ring annuloplasty changes mitral geometry acutely, exacerbates leaflet tethering, and generally fixes IMR acutely, but it does not always fix the delicate underlying chronic problem of continued left ventricular dilatation and remodeling. This may explain why pre-repair 3D valve geometry (which reflects chronic left ventricular remodeling) is highly predictive of recurrent IMR, whereas immediate post-repair 3D valve geometry (which does not completely reflect chronic left ventricular remodeling anymore) is not.

Authors+Show Affiliations

Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA. frankmeijerink@icloud.com. Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. frankmeijerink@icloud.com.Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA. Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA. Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA.Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA.Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA.Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA.Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.Department of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.Department of Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA. Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA. Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32616001

Citation

Meijerink, Frank, et al. "Intraoperative Post-annuloplasty Three-dimensional Valve Analysis Does Not Predict Recurrent Ischemic Mitral Regurgitation." Journal of Cardiothoracic Surgery, vol. 15, no. 1, 2020, p. 161.
Meijerink F, Wijdh-den Hamer IJ, Bouma W, et al. Intraoperative post-annuloplasty three-dimensional valve analysis does not predict recurrent ischemic mitral regurgitation. J Cardiothorac Surg. 2020;15(1):161.
Meijerink, F., Wijdh-den Hamer, I. J., Bouma, W., Pouch, A. M., Aly, A. H., Lai, E. K., Eperjesi, T. J., Acker, M. A., Yushkevich, P. A., Hung, J., Mariani, M. A., Khabbaz, K. R., Gleason, T. G., Mahmood, F., Gorman, J. H., & Gorman, R. C. (2020). Intraoperative post-annuloplasty three-dimensional valve analysis does not predict recurrent ischemic mitral regurgitation. Journal of Cardiothoracic Surgery, 15(1), 161. https://doi.org/10.1186/s13019-020-01138-7
Meijerink F, et al. Intraoperative Post-annuloplasty Three-dimensional Valve Analysis Does Not Predict Recurrent Ischemic Mitral Regurgitation. J Cardiothorac Surg. 2020 Jul 2;15(1):161. PubMed PMID: 32616001.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intraoperative post-annuloplasty three-dimensional valve analysis does not predict recurrent ischemic mitral regurgitation. AU - Meijerink,Frank, AU - Wijdh-den Hamer,Inez J, AU - Bouma,Wobbe, AU - Pouch,Alison M, AU - Aly,Ahmed H, AU - Lai,Eric K, AU - Eperjesi,Thomas J, AU - Acker,Michael A, AU - Yushkevich,Paul A, AU - Hung,Judy, AU - Mariani,Massimo A, AU - Khabbaz,Kamal R, AU - Gleason,Thomas G, AU - Mahmood,Feroze, AU - Gorman,Joseph H,3rd AU - Gorman,Robert C, Y1 - 2020/07/02/ PY - 2020/01/20/received PY - 2020/05/04/accepted PY - 2020/7/4/entrez PY - 2020/7/4/pubmed PY - 2020/7/4/medline KW - Ischemia ▪ mitral regurgitation ▪ mitral valve repair ▪ three-dimensional echocardiography SP - 161 EP - 161 JF - Journal of cardiothoracic surgery JO - J Cardiothorac Surg VL - 15 IS - 1 N2 - BACKGROUND: High ischemic mitral regurgitation (IMR) recurrence rates continue to plague IMR repair with undersized ring annuloplasty. We have previously shown that pre-repair three-dimensional echocardiography (3DE) analysis is highly predictive of IMR recurrence. The objective of this study was to determine the quantitative change in 3DE annular and leaflet tethering parameters immediately after repair and to determine if intraoperative post-repair 3DE parameters would be able to predict IMR recurrence 6 months after repair. METHODS: Intraoperative pre- and post-repair transesophageal real-time 3DE was performed in 35 patients undergoing undersized ring annuloplasty for IMR. An advanced modeling algorhythm was used to assess 3D annular geometry and regional leaflet tethering. IMR recurrence (≥ grade 2) was assessed with transthoracic echocardiography 6 months after repair. RESULTS: Annuloplasty significantly reduced septolateral diameter, commissural width, annular area, and tethering volume and significantly increased all segmental tethering angles (except A2). Intraoperative post-repair annular geometry and leaflet tethering did not differ significantly between patients with recurrent IMR (n = 9) and patients with non-recurrent IMR (n = 26). No intraoperative post-repair predictors of IMR recurrence could be identified. CONCLUSIONS: Undersized ring annuloplasty changes mitral geometry acutely, exacerbates leaflet tethering, and generally fixes IMR acutely, but it does not always fix the delicate underlying chronic problem of continued left ventricular dilatation and remodeling. This may explain why pre-repair 3D valve geometry (which reflects chronic left ventricular remodeling) is highly predictive of recurrent IMR, whereas immediate post-repair 3D valve geometry (which does not completely reflect chronic left ventricular remodeling anymore) is not. SN - 1749-8090 UR - https://www.unboundmedicine.com/medline/citation/32616001/Intraoperative_post-annuloplasty_three-dimensional_valve_analysis_does_not_predict_recurrent_ischemic_mitral_regurgitation L2 - https://cardiothoracicsurgery.biomedcentral.com/articles/10.1186/s13019-020-01138-7 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.