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Mitral Valve Geometry and Hemodynamics After Surgical Mitral Valve Annuloplasty and Implications for Percutaneous Treatment of Patients With Recurrent Mitral Regurgitation

      The feasibility of transcatheter mitral valve therapy (edge-to-edge or valve-in-ring technique) in patients with significant mitral regurgitation (MR) recurrence after surgical restrictive mitral valve annuloplasty remains unknown. The aim of the present study was to investigate the eligibility for transcatheter mitral valve therapy of high-surgical-risk patients with significant MR recurrence after initial successful restrictive mitral valve annuloplasty. A total of 47 patients (age 67 ± 10 years, 47% men) with significant MR recurrence (effective regurgitant orifice area ≥20 mm2, regurgitant volume ≥30 ml/beat, or vena contracta ≥3 mm) after restrictive mitral valve annuloplasty were identified. The long-term outcome of patients dichotomized according to the surgical risk was evaluated. The echocardiographic parameters of mitral valve geometry and hemodynamics at the moment of diagnosis of MR recurrence were assessed to evaluate the eligibility for transcatheter valve therapy. During a median follow-up of 3 years, 23 patients (48.9%) died. The patients with a high-surgical risk (logistic European System for Cardiac Operative Risk Evaluation score ≥20%) had significantly worse long-term survival than those with a low-surgical risk (logistic European System for Cardiac Operative Risk Evaluation score <20%; 50% and 88%, respectively; p = 0.002). All high-surgical-risk patients showed geometric mitral valve features that would allow transcatheter mitral valve therapy (mitral annular area 7 ± 2.0 cm2, coaptation length 6 ± 1.6 mm, anterior and posterior mitral leaflet length 24 ± 2.8 mm and 15 ± 3.1 mm, respectively). In conclusion, patients with significant MR recurrence after initial successful restrictive mitral valve annuloplasty and a high risk of redo mitral valve surgery had lower long-term survival rates than patients who could undergo repeat surgery.
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      References

        • Bursi F.
        • Enriquez-Sarano M.
        • Nkomo V.T.
        • Jacobsen S.J.
        • Weston S.A.
        • Meverden R.A.
        • Roger V.L.
        Heart failure and death after myocardial infarction in the community: the emerging role of mitral regurgitation.
        Circulation. 2005; 111: 295-301
        • Trichon B.H.
        • Felker G.M.
        • Shaw L.K.
        • Cabell C.H.
        • O'Connor C.M.
        Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure.
        Am J Cardiol. 2003; 91: 538-543
        • Bursi F.
        • Barbieri A.
        • Grigioni F.
        • Reggianini L.
        • Zanasi V.
        • Leuzzi C.
        • Ricci C.
        • Piovaccari G.
        • Branzi A.
        • Modena M.G.
        Prognostic implications of functional mitral regurgitation according to the severity of the underlying chronic heart failure: a long-term outcome study.
        Eur J Heart Fail. 2010; 12: 382-388
        • Rossi A.
        • Dini F.L.
        • Faggiano P.
        • Agricola E.
        • Cicoira M.
        • Frattini S.
        • Simioniuc A.
        • Gullace M.
        • Ghio S.
        • Enriquez-Sarano M.
        • Temporelli P.L.
        Independent prognostic value of functional mitral regurgitation in patients with heart failure: a quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy.
        Heart. 2011; 97: 1675-1680
        • Carabello B.A.
        The current therapy for mitral regurgitation.
        J Am Coll Cardiol. 2008; 52: 319-326
        • Bax J.J.
        • Braun J.
        • Somer S.T.
        • Klautz R.
        • Holman E.R.
        • Versteegh M.I.
        • Boersma E.
        • Schalij M.J.
        • van der Wall E.E.
        • Dion R.A.
        Restrictive annuloplasty and coronary revascularization in ischemic mitral regurgitation results in reverse left ventricular remodeling.
        Circulation. 2004; 110: II103-II108
        • Westenberg J.J.
        • van der Geest R.J.
        • Lamb H.J.
        • Versteegh M.I.
        • Braun J.
        • Doornbos J.
        • de R.A.
        • van der Wall E.E.
        • Dion R.A.
        • Reiber J.H.
        • Bax J.J.
        MRI to evaluate left atrial and ventricular reverse remodeling after restrictive mitral annuloplasty in dilated cardiomyopathy.
        Circulation. 2005; 112: I437-I442
        • Crabtree T.D.
        • Bailey M.S.
        • Moon M.R.
        • Munfakh N.
        • Pasque M.K.
        • Lawton J.S.
        • Moazami N.
        • Aubuchon K.A.
        • Al-Dadah A.S.
        • Damiano Jr., R.J.
        Recurrent mitral regurgitation and risk factors for early and late mortality after mitral valve repair for functional ischemic mitral regurgitation.
        Ann Thorac Surg. 2008; 85: 1537-1542
        • Magne J.
        • Senechal M.
        • Dumesnil J.G.
        • Pibarot P.
        Ischemic mitral regurgitation: a complex multifaceted disease.
        Cardiology. 2009; 112: 244-259
        • Tahta S.A.
        • Oury J.H.
        • Maxwell J.M.
        • Hiro S.P.
        • Duran C.M.
        Outcome after mitral valve repair for functional ischemic mitral regurgitation.
        J Heart Valve Dis. 2002; 11: 11-18
        • McGee E.C.
        • Gillinov A.M.
        • Blackstone E.H.
        • Rajeswaran J.
        • Cohen G.
        • Najam F.
        • Shiota T.
        • Sabik J.F.
        • Lytle B.W.
        • McCarthy P.M.
        • Cosgrove D.M.
        Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation.
        J Thorac Cardiovasc Surg. 2004; 128: 916-924
        • de Weger A.
        • Ewe S.H.
        • Delgado V.
        • Bax J.J.
        First-in-man implantation of a trans-catheter aortic valve in a mitral annuloplasty ring: novel treatment modality for failed mitral valve repair.
        Eur J Cardiothorac Surg. 2011; 39: 1054-1056
        • Lim D.S.
        • Kunjummen B.J.
        • Smalling R.
        Mitral valve repair with the MitraClip device after prior surgical mitral annuloplasty.
        Catheter Cardiovasc Interv. 2010; 76: 455-459
        • Himbert D.
        • Descoutures F.
        • Brochet E.
        • Iung B.
        • Detaint D.
        • Messika-Zeitoun D.
        • Alkhoder S.
        • Mimoun L.
        • Sordi M.
        • Depoix J.P.
        • Ducrocq G.
        • Nataf P.
        • Vahanian A.
        Transvenous mitral valve replacement after failure of surgical ring annuloplasty.
        J Am Coll Cardiol. 2012; 60: 1205-1206
        • Kondo N.
        • Shuto T.
        • McGarvey J.R.
        • Koomalsingh K.J.
        • Takebe M.
        • Gorman R.C.
        • Gorman III, J.H.
        • Gillespie M.J.
        Melody valve-in-ring procedure for mitral valve replacement: feasibility in four annuloplasty types.
        Ann Thorac Surg. 2012; 93: 783-788
        • Shuto T.
        • Kondo N.
        • Dori Y.
        • Koomalsingh K.J.
        • Glatz A.C.
        • Rome J.J.
        • Gorman III, J.H.
        • Gorman R.C.
        • Gillespie M.J.
        Percutaneous transvenous Melody valve-in-ring procedure for mitral valve replacement.
        J Am Coll Cardiol. 2011; 58: 2475-2480
        • Kempfert J.
        • Blumenstein J.
        • Chu M.W.
        • Pritzwald-Stegmann P.
        • Kobilke T.
        • Falk V.
        • Mohr F.W.
        • Walther T.
        Minimally invasive off-pump valve-in-a-ring implantation: the atrial transcatheter approach for re-operative mitral valve replacement after failed repair.
        Eur J Cardiothorac Surg. 2009; 35: 965-969
        • Ciarka A.
        • Braun J.
        • Delgado V.
        • Versteegh M.
        • Boersma E.
        • Klautz R.
        • Dion R.
        • Bax J.J.
        • Van de Veire N.
        Predictors of mitral regurgitation recurrence in patients with heart failure undergoing mitral valve annuloplasty.
        Am J Cardiol. 2010; 106: 395-401
        • Lang R.M.
        • Bierig M.
        • Devereux R.B.
        • Flachskampf F.A.
        • Foster E.
        • Pellikka P.A.
        • Picard M.H.
        • Roman M.J.
        • Seward J.
        • Shanewise J.S.
        • Solomon S.D.
        • Spencer K.T.
        • Sutton M.S.
        • Stewart W.J.
        Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.
        J Am Soc Echocardiogr. 2005; 18: 1440-1463
        • Zoghbi W.A.
        • Enriquez-Sarano M.
        • Foster E.
        • Grayburn P.A.
        • Kraft C.D.
        • Levine R.A.
        • Nihoyannopoulos P.
        • Otto C.M.
        • Quinones M.A.
        • Rakowski H.
        • Stewart W.J.
        • Waggoner A.
        • Weissman N.J.
        Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography.
        J Am Soc Echocardiogr. 2003; 16: 777-802
        • Lee A.P.
        • Acker M.
        • Kubo S.H.
        • Bolling S.F.
        • Park S.W.
        • Bruce C.J.
        • Oh J.K.
        Mechanisms of recurrent functional mitral regurgitation after mitral valve repair in nonischemic dilated cardiomyopathy: importance of distal anterior leaflet tethering.
        Circulation. 2009; 119: 2606-2614
        • Magne J.
        • Pibarot P.
        • Dagenais F.
        • Hachicha Z.
        • Dumesnil J.G.
        • Senechal M.
        Preoperative posterior leaflet angle accurately predicts outcome after restrictive mitral valve annuloplasty for ischemic mitral regurgitation.
        Circulation. 2007; 115: 782-791
        • Vijayaraghavan G.
        • Boltwood C.M.
        • Tei C.
        • Wong M.
        • Shah P.M.
        Simplified echocardiographic measurement of the mitral anulus.
        Am Heart J. 1986; 112: 985-991
        • Feldman T.
        • Kar S.
        • Rinaldi M.
        • Fail P.
        • Hermiller J.
        • Smalling R.
        • Whitlow P.L.
        • Gray W.
        • Low R.
        • Herrmann H.C.
        • Lim S.
        • Foster E.
        • Glower D.
        Percutaneous mitral repair with the MitraClip system: safety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort.
        J Am Coll Cardiol. 2009; 54: 686-694
        • Petronio A.
        • Giannini C.
        • De C.M.
        • Guarracino F.
        Antegrade percutaneous valve implantation for mitral ring dysfunction, a challenging case.
        Catheter Cardiovasc Interv. 2012; 80: 700-703
        • Casselman F.
        • Martens S.
        • De B.B.
        • Degrieck I.
        Reducing operative mortality in valvular reoperations: the “valve in ring” procedure.
        J Thorac Cardiovasc Surg. 2011; 141: 1317-1318
        • Delgado V.
        • Kapadia S.
        • Marsan N.A.
        • Schalij M.J.
        • Tuzcu E.M.
        • Bax J.J.
        Multimodality imaging before, during, and after percutaneous mitral valve repair.
        Heart. 2011; 97: 1704-1714
        • Gurvitch R.
        • Cheung A.
        • Ye J.
        • Wood D.A.
        • Willson A.B.
        • Toggweiler S.
        • Binder R.
        • Webb J.G.
        Transcatheter valve-in-valve implantation for failed surgical bioprosthetic valves.
        J Am Coll Cardiol. 2011; 58: 2196-2209
        • Casselman F.P.
        • La M.M.
        • Jeanmart H.
        • Mazzarro E.
        • Coddens J.
        • Van P.F.
        • Wellens F.
        • Vermeulen Y.
        • Vanermen H.
        Endoscopic mitral and tricuspid valve surgery after previous cardiac surgery.
        Circulation. 2007; 116: I270-I275