The value of preoperative 3-dimensional over 2-dimensional valve analysis in predicting recurrent ischemic mitral regurgitation after mitral annuloplasty

Inez J. Wijdh-den Hamer, Wobbe Bouma, Eric K. Lai, Melissa M. Levack, Eric K. Shang, Alison M. Pouch, Thomas J. Eperjesi, Theodore J. Plappert, Paul A. Yushkevich, Judy Hung, Massimo A. Mariani, Kamal R. Khabbaz, Thomas G. Gleason, Feroze Mahmood, Michael A. Acker, Y. Joseph Woo, Albert T. Cheung, Matthew J. Gillespie, Benjamin M. Jackson, Joseph H. GormanRobert C. Gorman

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

Objectives Repair for ischemic mitral regurgitation with undersized annuloplasty is characterized by high recurrence rates. We sought to determine the value of pre-repair 3-dimensional echocardiography over 2-dimensional echocardiography in predicting recurrence at 6 months. Methods Intraoperative transesophageal 2-dimensional echocardiography and 3-dimensional echocardiography were performed in 50 patients undergoing undersized annuloplasty for ischemic mitral regurgitation. Two-dimensional echocardiography annular diameter and tethering parameters were measured in the apical 2- and 4-chamber views. A customized protocol was used to assess 3-dimensional annular geometry and regional leaflet tethering. Recurrence (grade ≥2) was assessed with 2-dimensional transthoracic echocardiography at 6 months. Results Preoperative 2- and 3-dimensional annular geometry were similar in all patients with ischemic mitral regurgitation. Preoperative 2- and 3-dimensional leaflet tethering were significantly higher in patients with recurrence (n = 13) when compared with patients without recurrence (n = 37). Multivariate logistic regression revealed preoperative 2-dimensional echocardiography posterior tethering angle as an independent predictor of recurrence with an optimal cutoff value of 32.0° (area under the curve, 0.81; 95% confidence interval, 0.68-0.95; P = .002) and preoperative 3-dimensional echocardiography P3 tethering angle as an independent predictor of recurrence with an optimal cutoff value of 29.9° (area under the curve, 0.92; 95% confidence interval, 0.84-1.00; P < .001). The predictive value of the 3-dimensional geometric multivariate model can be augmented by adding basal aneurysm/dyskinesis (area under the curve, 0.94; 95% confidence interval, 0.87-1.00; P < .001). Conclusions Preoperative 3-dimensional echocardiography P3 tethering angle is a stronger predictor of ischemic mitral regurgitation recurrence after annuloplasty than preoperative 2-dimensional echocardiography posterior tethering angle, which is highly influenced by viewing plane. In patients with a preoperative P3 tethering angle of 29.9° or larger (especially when combined with basal aneurysm/dyskinesis), chordal-sparing valve replacement should be strongly considered.

Original languageEnglish
Pages (from-to)847-859
Number of pages13
JournalJournal of Thoracic and Cardiovascular Surgery
Volume152
Issue number3
DOIs
StatePublished - 2016
Externally publishedYes

Keywords

  • echocardiography
  • ischemia
  • mitral regurgitation
  • mitral valve repair

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