Key result
Surgery for primary mitral regurgitation led to an early reduction in left ventricular end-diastolic volume index from 119 to 75 mL/m2, followed by late improvement in ejection fraction.
Why the study?
The short- and long-term effects of volume overload elimination on LV volumetric reverse-remodeling and systemic hemodynamics after surgery for chronic primary MR were poorly explored.
Does surgery for primary mitral regurgitation induce left ventricular volumetric reverse-remodeling?
Cohort (n=224)
Does surgery for primary mitral regurgitation induce left ventricular volumetric reverse-remodeling?
Left ventricular reverse remodeling after primary mitral regurgitation surgery is a phased process, with early EDV reduction driven by MR elimination and late improvement in LV systolic function.
Answers are grounded in this paper and cite their sources.
Indicates favorable LV remodeling after surgery; leaves open effects on clinical outcomes in primary MR.
Background The short and long-term effects of volume overload elimination on left ventricular (LV) volumetric reverse-remodeling and systemic hemodynamic after surgery for chronic primary mitral regurgitation (MR) have been poorly explored. Methods 224 patients (64 ± 13 years) with primary MR underwent serial MR and LV volumetric measurements at baseline, early (5[4–6] days) and late (428 [355–688] days) after surgery. Results Early after surgery, the drop in LV end-diastolic volume (EDV index: 119 ± 25 to 75 ± 14 mL/m 2 , P < 0.0001) was tightly related to pre-operative regurgitant volume (RVol; r=0.88, P < 0.0001) while end-systolic volume (ESV) index did not change. Although LV ejection fraction (EF) decreased (71 ± 8 to 54 ± 12%, P < 0.0001), forward stroke volume was maintained (P = 0.28). Patients with greater RVol experienced a greater decrease in EDV and LVEF. Later, ESV index decreased (P < 0.0001), EDV index decreased further and LVEF improved to 60 ± 8% (P < 0.0001). Finally, systemic vascular function changes were characterized by an improvement in resistance and compliance. Conclusion LV volumetric reverse-remodeling after surgery for primary MR is a phased process. The initial response is driven essentially by elimination of MR with a greater decline in EF in patients with larger RVol. In the late phase LV systolic function improvement is generally observed. Overall, the degree of LV reverse-remodeling is related to the magnitude of RVol, which predicts the early decline in EDV. Finally, LV reverse-remodeling is associated to systemic vascular function remodeling.
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Tourneau et al. (2019) conducted a cohort in chronic primary mitral regurgitation (n=224). Surgery for primary mitral regurgitation vs. Baseline (pre-operative) was evaluated on Left ventricular end-diastolic volume (EDV) index early after surgery (p=<0.0001). Surgery for primary mitral regurgitation led to an early reduction in left ventricular end-diastolic volume index from 119 to 75 mL/m2, followed by late improvement in ejection fraction.
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