Key result
Intraoperative post-repair 3D echocardiographic annular geometry and leaflet tethering parameters did not differ significantly between patients with and without recurrent ischemic mitral regurgitation and could not predict recurrence at 6 months.
Why the study?
High IMR recurrence rates persist after undersized ring annuloplasty, prompting evaluation of whether intraoperative post-repair 3DE annular and leaflet tethering parameters can predict recurrence.
Does intraoperative post-repair 3D echocardiography predict recurrent ischemic mitral regurgitation at 6 months in patients undergoing undersized ring annuloplasty?
Cohort (n=35)
Yes
Does intraoperative post-repair 3D echocardiography predict recurrent ischemic mitral regurgitation at 6 months in patients undergoing undersized ring annuloplasty?
Intraoperative post-repair 3D echocardiography parameters do not predict recurrent ischemic mitral regurgitation at 6 months, unlike pre-repair geometry.
Answers are grounded in this paper and cite their sources.
Should not guide annuloplasty decisions using post-repair 3D parameters; leaves open whether pre-repair geometry aids recurrence prediction.
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.
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Meijerink et al. (2020) conducted a cohort in Severe ischemic mitral regurgitation (n=35). Intraoperative post-repair 3D echocardiographic parameters vs. Patients without recurrent IMR was evaluated on Recurrent ischemic mitral regurgitation (≥ grade 2) at 6 months (p=>0.05). Intraoperative post-repair 3D echocardiographic annular geometry and leaflet tethering parameters did not differ significantly between patients with and without recurrent ischemic mitral regurgitation and could not predict recurrence at 6 months.
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