Perioperative Predictors for Recurrence of Mitral Regurgitation after Surgery for Ischemic Mitral Regurgitation

ABSTRACT

BACKGROUND AND OBJECTIVES : In clinical practice, significant recurrence of mitral regurgitation (MR) is observed frequently even after surgical treatment for ischemic MR (IMR). The purpose of this study is to evaluate the recurrence rate of MR and to investigate perioperative predictors for its recurrence following surgery for IMR. SUBJECTS AND METHODS : We retrospectively analyzed 106 patients who underwent surgical management for IMR. Echocardiographic parameters, such as severity of MR, ejection fraction, diastolic left ventricular (LV) dimension, systolic LV dimension, left atrial size, LV sphericity index, mitral valve (MV) tenting area, MV tenting height (TH), tethering distance, MV intraleaflet angle (MVILa), and MV intraleaflet height (MVILh) were measured. RESULTS : Two types of surgery were performed to treat IMR, including valvuloplasty combined with coronary artery bypass graft (CABG)(group A, n=79) and LV volume reduction surgery combined with CABG (group B, n=27). Significant MR was detected echocardiographically 5.4+/-6.7 months after the surgery. The overall recurrence rate of MR was 17% (n=18), and 15.2% (n=12) in group A and 22.2% (n=6) in group B. The preoperative TH and the postoperative MVILh were independent perioperative predictors for the recurrence of significant MR according to multiple logistic regression analysis (p<0.05, respectively). CONCLUSION : The overall postoperative recurrence rate of significant MR after surgical repair is 17% within 6 months. Independent perioperative predictors of recurrent MR after surgery for IMR are the preoperative TH and the postoperative MVILh. For better outcomes in IMR management, those two factors should be considered in the surgical repair of IMR.