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Does repair of mitral regurgitation eliminate the need for left ventricular volume reduction?
Akira T Kawaguchi1, Hratch L Karamanoukian, Lise O Bocchino
1Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa, Japan. akira@is.icc.u-tokai.ac.jp
Background:
Effects of partial left ventriculectomy (PLV) remain ill-defined because mitral regurgitation (MR) repair by isolated annuloplasty alone has been reported to improve patients with dilated left ventricle and severe MR.
Methods:
Among patients undergoing PLV, 120 had paired pre- and postoperative (<1 week) Doppler echocardiograms. Effects of preoperative MR were studied by comparing 45 patients with no preoperative MR (MR-) and 75 patients with significant MR (MR+; MR = 1.51 when MR is enumerated as none = 0, mild = 1, moderate = 2).
Results:
MR- patients as compared with the MR+ group were older (53.8 vs. 49.2 years, P = 0.047), had less frequent dilated cardiomyopathy (33.3% vs 49.3%,P <0.01), similar ventricular dimension (72.3 mm vs 73.0 mm), septal thickness (9.5 mm vs 9.6 mm), posterior wall, fractional shortening (15.9% vs 16.8%) and ventricular mass (330 g vs 345 g), resulting in comparably reduced functional capacity (NYHA 3.40 vs 3.67). Although the MR- group required significantly less frequent mitral procedure (64.4% vs 84.0%, P < 0.01) and shorter cardiac arrest time, they had similar postoperative MR (0.22 vs 0.39), highly significant parallel reduction in ventricular dimension (P < 0.001 in either group), and improved %FS (P <0.001 in either group), resulting in similar hospital survival (87.1% vs 86.4%) and 90-day survival (71.1% vs 78.7%) with significantly comparable improvement in functional class (P = 0.011 in both groups). Histological severity of interstitial fibrosis (P = 0.80), weight (P = 0.93), and thickness (P = 0.76) of excised myocardium was comparable between the two groups.
Conclusion:
Patients with no preoperative MR were found to benefit from PLV as did patients with significant MR. Beneficial effects of PLV appeared to derive mainly from volume reduction rather than abolished MR in this study.
Insights
Partial left ventriculectomy (PLV) benefits patients with and without preoperative mitral regurgitation (MR). The positive outcomes of PLV appear primarily driven by left ventricular volume reduction, not solely by MR correction.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Ventricular Remodeling
Background:
- The efficacy of partial left ventriculectomy (PLV) is debated, particularly when compared to isolated mitral regurgitation (MR) repair.
- Mitral regurgitation repair via annuloplasty alone can improve outcomes in patients with dilated left ventricles and severe MR.
Purpose of the Study:
- To evaluate the effects of PLV in patients with and without preoperative mitral regurgitation.
- To determine if the benefits of PLV are primarily due to MR correction or ventricular volume reduction.
Main Methods:
- A retrospective analysis of 120 patients undergoing PLV with paired pre- and postoperative echocardiograms.
- Comparison of outcomes between patients with no significant preoperative MR (MR-) and those with significant preoperative MR (MR+).
Main Results:
- Both MR- and MR+ groups showed significant reductions in ventricular dimensions and improvements in fractional shortening post-PLV.
- Hospital and 90-day survival rates were similar between the MR- and MR+ groups.
- Functional class improvement was comparable in both groups, suggesting benefits beyond MR correction.
Conclusions:
- Partial left ventriculectomy provides benefits to patients regardless of their preoperative mitral regurgitation status.
- The primary mechanism for PLV's beneficial effects in this cohort appears to be left ventricular volume reduction.