Why the study?
The clinical impacts and standardized definition of functional mitral stenosis after degenerative mitral regurgitation repair remain undecided, and common hemodynamic parameters are flow-dependent.
Does flow adjusted transmitral pressure gradient predict postoperative adverse cardiac events in patients who underwent isolated mitral valve repair for degenerative mitral regurgitation?
Does flow adjusted transmitral pressure gradient predict postoperative adverse cardiac events in patients who underwent isolated mitral valve repair for degenerative mitral regurgitation?
Flow adjusted transmitral pressure gradient (TMPG/LVSV) may serve as a more sensitive indicator of functional mitral stenosis and predictor of adverse cardiac events after mitral valve repair than conventional hemodynamic parameters.
Flow-adjusted TMPG independently predicted adverse events after DMR repair; leaves open whether it refines FMS assessment or changes practice.
BACKGROUND AND AIM: After repair of degenerative mitral regurgitation (DMR), the focus is on functional mitral stenosis (FMS) when there is a decline of mitral hemodynamics. Yet, the clinical impacts and a standardized definition are still undecided. Since common mitral hemodynamic parameters are influenced by transmitral flow, the aim of this study is to seek the impact of flow adjusted transmitral pressure gradient (TMPG) by left ventricular stroke volume (LVSV) on the midterm outcomes. METHODS: Three hundred one patients who had undergone isolated mitral valve repair for degenerative lesions with annuloplasty prosthesis between October 2012 and June 2019 were included. Postoperative adverse events occurred in 20 patients (6.6%). Flow adjusted TMPG was defined as TMPG/LVSV. RESULTS: Common mitral hemodynamic parameters were not associated with adverse events. By multivariable analysis, patients' age, left ventricular ejection fraction (LVEF) and mean TMPG/LVSV were isolated as independent predictors (adjusted hazard ratio: 1.05, 0.95, and 1.16; p = .037, .005, and .035). Flow adjusted TMPG was significantly higher in the full ring group compared to the partial band group (0.051 mmHg/ml, [0.038-0.068] vs. 0.041 mmHg/ml, [0.031-0.056]; p < .001) and had a significantly negative correlation with the size of the annuloplasty prosthesis (r = -0.37, p < .001). CONCLUSIONS: Conventional mitral hemodynamic parameters were not associated with adverse cardiac events after repair for DMR. Adjustment by flow has a potential to advance pressure gradient to a more sensitive indicator of FMS associated with clinical outcomes.
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Hiraoka et al. (2022) studied this question.
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