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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Mitral valve repair in ischemic mitral regurgitation
Antonio Maria Calafiore1, Michele Di Mauro, Marco Contini
1Division of Cardiac Surgery, University Hospital, "S. Giovanni Battista", c.so Bramante 86, Turin, Italy.
Abstract:
Ischemic mitral regurgitation (IMR) is a common complication after acute myocardial infarction due to annulus dilatation and papillary muscles displacement. In our opinion 3/4 and 4/4 IMR have always to be indicated for MV surgery. In presence of low EF and dilated LV, moderate (2/4) IMR has to be corrected. The end-systolic distance between the coaptation point of mitral leaflets and the plane of mitral valve annulus is the key point to decide repair (≦10 mm) or replacement (≫10 mm). MV annuloplasty has always been addressed to the posterior annulus, whose size can be easily reduced. A specially designed 40 mm long ring has been used to achieve a posterior overreductive annuloplasty. For MV repair thirty-day mortality was 2.4%. Five-year survival and the possibility of being alive and in NYHA class I-II were 75.6±4.7 and 59.8±5.4, respectively. After a mean of 38±35 months, the NYHA class decreases from 3.2±0.5 to 2.1±0.6 (P≪0.001). Most patients (77.4%) have an improvement of its own functional class. MR decreases from 3.2±0.8 to 1.2±1.1 (P≪0.001). 97.5% of the survivors have MR equal to or less than moderate.
Insights
Ischemic mitral regurgitation (IMR) after myocardial infarction requires surgical intervention, especially for severe cases. Mitral valve annuloplasty using a posterior over-reduction technique improves functional class and reduces regurgitation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomedical Engineering
Background:
- Ischemic mitral regurgitation (IMR) is a frequent complication of acute myocardial infarction.
- It results from left ventricular remodeling, including annulus dilatation and papillary muscle displacement.
- The severity of IMR dictates the need for surgical intervention.
Purpose of the Study:
- To evaluate the efficacy of mitral valve annuloplasty for treating ischemic mitral regurgitation.
- To establish criteria for deciding between mitral valve repair versus replacement.
- To assess long-term survival and functional outcomes after surgical correction of IMR.
Main Methods:
- Surgical intervention for IMR, with specific indications for 3/4 and 4/4 IMR, and moderate (2/4) IMR in patients with low ejection fraction (EF) and dilated left ventricle (LV).
- Decision-making for mitral valve repair or replacement based on end-systolic distance between mitral leaflets coaptation point and annulus (≦10 mm for repair, ≫10 mm for replacement).
- Posterior over-reductive annuloplasty using a specially designed 40 mm ring.
Main Results:
- Thirty-day mortality for mitral valve repair was 2.4%.
- Five-year survival was 75.6±4.7%, with 59.8±5.4% of patients in NYHA class I-II.
- Mean NYHA class improved from 3.2±0.5 to 2.1±0.6 (P≪0.001), with 77.4% of patients showing functional improvement. Mitral regurgitation (MR) decreased from 3.2±0.8 to 1.2±1.1 (P≪0.001), with 97.5% of survivors having MR ≤ moderate.
Conclusions:
- Mitral valve annuloplasty is effective in treating ischemic mitral regurgitation.
- The proposed criteria for repair versus replacement are clinically relevant.
- Surgical correction leads to significant long-term improvements in survival and functional status.
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