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Circulation. 2016 Oct 25;134(17):1247-1256.

Impact of Left Ventricular to Mitral Valve Ring Mismatch on Recurrent Ischemic Mitral Regurgitation After Ring Annuloplasty.

Author information

1
From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.).
2
From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.). jhung@mgh.harvard.edu.

Abstract

BACKGROUND:

In ischemic mitral regurgitation (IMR), ring annuloplasty is associated with a significant rate of recurrent MR. Ring size is based on intertrigonal distance without consideration of left ventricular (LV) size. However, LV size is an important determinant of mitral valve (MV) leaflet tethering before and after repair. We aimed to determine whether LV-MV ring mismatch (mismatch of LV size relative to ring size) is associated with recurrent MR in patients with IMR after restrictive ring annuloplasty.

METHODS:

Patients with moderate or severe IMR from the 2 Cardiothoracic Surgical Trials Network IMR trials who received MV repair were examined at 1 year after surgery. Baseline LV size was assessed by LV end-diastolic dimension and LV end-systolic dimension (LVESd). LV-MV ring mismatch was calculated as the ratio of LV to ring size (LV end-diastolic dimension/ring size and LVESd/ring size).

RESULTS:

At 1 year after ring annuloplasty, 45 of 214 patients with MV repair (21%) had moderate or greater MR. In univariable logistic regression analysis, larger LVESd (P=0.02) and LVESd/ring size (P=0.007) were associated with recurrent MR. In multivariable models adjusted for age, sex, baseline LV ejection fraction, and severe IMR, only LVESd/ring size (odd ratio per 0.5 increase, 2.20; 95% confidence interval, 1.05-4.62; P=0.038) remained significantly associated with 1-year MR recurrence.

CONCLUSIONS:

LV-MV ring size mismatch is associated with increased risk of MR recurrence. This finding may be helpful in guiding choice of ring size to prevent recurrent MR in patients undergoing MV repair and in identifying patients who may benefit from MV repair with additional subvalvular intervention or MV replacement rather than repair alone.

CLINICAL TRIAL REGISTRATION:

URL:http://clinicaltrials.gov. Unique identifiers: NCT00806988 and NCT00807040.

KEYWORDS:

ischemic heart disease; mitral regurgitation; mitral valve; mitral valve annuloplasty

PMID:
27777294
PMCID:
PMC5111875
DOI:
10.1161/CIRCULATIONAHA.115.021014
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

and Disclosures: GA has served as consultant for Abbott Vascular, Edwards and Atricure. DA has served as consultant for Celldon Corp. PG has served as consultant for Abbott Vascular, Tendyne and Bracco Diagnostics; has received research funding from Abbott Vascular, Edwards Lifesciences, Medtronic, Boston Scientific and Tendyne; has Echo Core Laboratory contracts from Valtech Cardio, Tendyne. MM sits at the Steering Committees of trials for Edwards Lifesciences and Abbott Vascular (uncompensated); has received travel expenses paid for committee meetings. The other authors have reported no relationships relevant to the contents of this paper to disclose.

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