Recent Echocardiography Parameters for Predicting Better Functional Result after Mitral Valve Correction Surgery in Patients with Primary Mitral Regurgitation
Objectives We analyzed whether some echocardiographic parameters are good predictors of functional result after mitral valve correction surgery.
Background Ejection fraction was not the only parameter to decide optimal time for surgery, nor an indicator for a better functional result after surgery. Severity measurement being a main consideration in surgery decision. Reduced left ventricle dimension after surgery reflect a better functional result.
Methods In 2019, 67 patients was included in this analysis. Age 53 (17-67) years, male 52,2%. All patients are with severe primary mitral regurgitation and treated by mitral valve surgery (mitral valve repair or replacement). Retrospective echocardiographic analysis was performed, to find the best parameter for predicting better functional outcome after surgery.
Results Data was collected from January to December 2019. From 262 primary mitral valve surgery underwent in National Heart Center Harapan Kita, there was 67 patients included, the other was excluded due to probability of secondary mitral regurgitation mechanism, concomitant congenital heart disease and or other significant valves disease, missing post-surgery data due to referral flow to the prior hospital and less complete echocardiographic views for further analysis. In bivariate analysis, end-diastolic volume (EDV) and regurgitant volume (RV) were strong predictor of decreasing left ventricle diameter after surgery (p 0.0001 and p 0.05). End-diastolic volume 133,5 ml or more is predictive for decreasing left ventricle diameter if surgery was conducted (sensitivity 87.3%, sensitivity 66.7%).
Conclusions EDV and RV found to be good predictors for functional outcome of primary mitral valve surgery than other echocardiographic parameters. Measuring EDV before deciding timing of surgery will be helpful in targeting better functional result after surgery.
2. Ross J Jr. Afterload mismatch in aortic and mitral valve disease: implications for surgical therapy. J Am Coll Cardiol. 1985; 5: 811–826
3. William H. Gaasch and MD Theo E. MeyerMD, PhD From the Departements of Cardiovascular Medicine, Lahey Clinic, Burlington, Mass, and University of Massachusetts Medical School, Worcester, Mass. Left Ventricular Response to Mitral Regurgitation. Implications for Management. Circulation. 2008.
4. Le Tourneau T, Messika-Zeitoun D, Russo A, Detaint D, Topilsky Y, Mahoney DW, Suri R & Enriquez-Sarano M 2010 Impact of left atrial volume on clinical outcome in organic mitral regurgitation. Journal of the American College of Cardiology 56 570–578. (doi:10.1016/j.jacc.2010.02.059)
5. Grigioni F, Avierinos JF, Ling LH, Scott CG, Bailey KR, Tajik AJ, Frye RL & Enriquez-Sarano M 2002 Atrial fibrillation complicating the course of degenerative mitral regurgitation: determinants and long-term outcome. Journal of the American College of Cardiology 40 84–92. (doi:10.1016/S0735-1097(02)01922-8)
6. Enriquez-Sarano M, Suri RM, Clavel MA, Mantovani F, Michelena HI, Pislaru S, Mahoney DW & Schaff HV 2015 Is there an outcome penalty linked to guideline-based indications for valvular surgery? Early and long-term analysis of patients with organic mitral regurgitation. Journal of Thoracic and Cardiovascular Surgery 150 50–58. (doi:10.1016/j.jtcvs.2015.04.009)
7. Flemming MA, Oral H, Rothman ED, Briesmiester K, Petrusha JA, Starling MR. Echocardiographic markers for mitral valve surgery to preserve left ventricular performance in mitral regurgitation. Am Heart J 2000;140:476–82.
8. Christophe Tribouilloy, Dan Rusinaru, Catherine Szymanski, Sonia Mezghani, Alexander Fournier, Franck Levy, Marcel Peltier, Ammar Ben Ammar, Doron Carmi, Jean-Paul Remadi, Thierry Caus, Gilles Touati. Predicting left ventricular dysfunction after valve repair for mitral regurgitation due to leaflet prolapse: additive value of left ventricular end-systolic dimension to ejection fraction. European Journal of Echocardiography. 2011;12:702-710.
9. Boyang Liu, Nicola C Edwards, Simon Ray, Richard P. Steeds. Timing surgery in mitral regurgitation: defining risk and optimising intervention using stress echocardiography. Downloaded from Bioscientifica.com at 03/10/2020 12:13:08PM via free access.
10. Crawford MH, Souchek J, Oprian CA, Miller DC, Rahimtoola S, Giacomini JC, et al. Determinants of survival and left ventricular performance after mitral valve replacement. Department of Veterans Affairs Cooperative Study on Valvular Heart Disease. Circulation 1990;81:1173–81.
11. Hyue Mee Kim, Goo-Yeong Cho, In-Chang Hwang, Hong-Mi Choi, Jun-Bean Park, Yeonyee E. Yoon, Hyung-Kwan Kim. Myocardial strain in Prediction of Outcomes After Surgery for Severe Mitral Regurgitation. J Am Coll Cardiol Img. 2018;11: 1235- 44.
12. Jong-Min Song, Se Hun Kang, Eun-Jeong Lee, Min-Jung Shin, Jae Won Lee, Cheol Hyun Chung, Dae-Hee Kim, Duk-Hyun Kang, Jae-Kwan Song. Echocardiographic Predictors of Left Ventricular Function and Clinical Outcomes After Successful Mitral Valve Repair: Conventional Two-Dimensonal Versus Speckle-Tracking Parameters. Ann Thorac Surg 2011;91: 1816-23.
13. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1–39.e14.
14. Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, et al. Recommendations for non-invasive evaluation of native valvular regurgitation: A report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr doi:10.1016/j.echo.2017.01.007.
15. Bonow RO, Carabello BA, Chatterje K, e t al. ACC/AHA 2006 guidelines for managemnet of patient with valvular heart disease: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2006.;48:48:e1–148.
16. Vahanian A, Baumgartner H, Bax J, et al. Guidelines on the management of valvular heart disease. The Task Force on teh Management of Valvular Heart Disease of The European Society of Cardiology. Eur Heart J 2007;28:230–68.
17. Tomasz GW, James DT, Victoria D, et al. Changes in Left Ventricular Function After Mitral Valve Repair for Severe Organic Mitral Regurgitation. Ann Thoracic Surg 2012;93:754–60.
18. Clancy KF, Hakki AH, Iskandrian AS, et al. Forward ejection fraction: a new index of left ventricular function in mitral regurgitation. Am Heart J 1985;110:658–64.
19. Enriquez-Sarano M, Bailey KR, Seward JB, Tajik AJ, Krohn MJ, Mays JM. Quantitative Doppler assesment of valvular regurgitation. Circulation 1993;87:841–8.
20. Braunwald E. Mitral regurgitation: physiologic, clinical and surgical considerations. N Engl J Med 1969;281:425–33.
21. Peter C, Chi Young S, Geu-Ru H, et al. Time course of left atrial reverse remodelling after mitral valve surgery and the impact of left ventricular global longitudinal strain in patients with chronic severe mitral regurgitation. Interactive CardioVascular and Thoracic Surgery 2016;23:876–882.
22. Lucia RM, Zilda MM, David CS, et al. Preoperative left ventricular ejection fraction and left atrium reverse remodelling after mitral regurgitation surgery. Cardiovasc Ultrasound 2014;12:45.
23. F Antonini-Canterin et al. Left Atrial Remodelling Early After Mitral Valve Repair for Degenerative Mitral Regurgitation. Heart 2008 Jul;94(7):935.
24. Philippe P, Victoria D, Jeroen JB. MITRA-FR vs COAPT: lessons from two trials with diametrically opposed results. European Heart Journal-Cardiovascular Imaging 2019;20:6:620-624.
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