Key result
Preoperative LVESVI predicts discharge values, while larger annuloplasty rings and lower mitral gradients drive favorable remodeling.
Why the study?
Predictors of reverse LV remodeling after mitral valve repair guide perioperative decision-making, but prospective randomized data supporting these predictor criteria remain scarce.
Does leaflet resection compared to preservation strategy affect left ventricular reverse remodeling in patients undergoing mitral repair?
RCT (n=104)
Blinded outcome assessment
1:1
Yes
Does leaflet resection compared to preservation strategy affect left ventricular reverse remodeling in patients undergoing mitral repair?
Effect estimate: Coefficient 0.84 (95% CI 0.51-1.17)
p-value: p=<0.001
Preoperative left ventricular dimensions and postoperative mitral valve hemodynamics, rather than the specific surgical repair technique, are the primary predictors of left ventricular reverse remodeling after mitral repair.
Repair technique does not affect LV remodeling; confirms preoperative LVESVi and postoperative hemodynamics as primary predictors.
BACKGROUND: Although predictors of reverse left ventricular (LV) remodeling postmitral valve repair are critical for guiding perioperative decision-making, there remains a paucity of randomized, prospective data to support the criteria that potential predictor variables must meet. METHODS AND RESULTS: The CAMRA CardioLink-2 randomized trial allocated 104 patients to either leaflet resection or preservation strategies for mitral repair. The correlation of indexed left ventricular end-systolic volume (LVESVI), indexed left ventricular end-diastolic volume (LVEDVI), and left ventricular ejection fraction (LVEF) were tested with univariate analysis and subsequently with multivariate analysis to determine independent predictors of reverse remodeling at discharge and at 12 months postoperatively. At discharge, both LVESVI and LVEDVI were independently associated with their preoperative values (p < .001 for both) and LVEF by preoperative LVESVI (p < .001). Mitral ring size was favorably associated with the change in LVESVI (p < .05) and LVEF (p < .01) from predischarge to 12 months, while the mean mitral valve gradient after repair was adversely associated with the change in LVESVI (p < .05) and LVEDVI (p < .05). No significant associations were found between reverse remodeling and coaptation height nor mitral repair technique. CONCLUSIONS: Beyond confirming the lack of impact of mitral repair technique on reverse remodeling, this investigation suggests that recommending surgery before significant LV dilatation or dysfunction, as well as higher postoperative mitral valve hemodynamic performance, may enhance remodeling capacity following mitral repair.
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Hibino et al. (2022) conducted an RCT in Primary, degenerative mitral regurgitation (posterior mitral valve prolapse) (n=104). Leaflet resection vs. Leaflet preservation was evaluated on Discharge left ventricular end-systolic volume index (LVESVI) predicted by preoperative LVESVI (Coefficient 0.84, 95% CI 0.51-1.17, p=<0.001). Preoperative left ventricular end-systolic volume index independently predicted discharge values (Coefficient 0.84), while larger annuloplasty ring size and lower mitral gradients predicted favorable remodeling at 12 months.
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