Predictive value of less than moderate residual mitral regurgitation as assessed by transesophageal echocardiography for the sho

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Abstract

Traditionally, in patients with mitral regurgitation (MR) a successful mitral valve repair is considered when residual MR by post-pump transesophageal echocardiography (TEE) is less than moderate or absent. Little is known about the prognostic value of less than moderate (mild or mild-to-moderate) residual MR for the early outcome of patients treated with mitral valve repair.

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Methods
Eligible for this study were patients undergoing isolated mitral valve repair. Patients with moderate or severe residual MR after valve repair were excluded. The primary endpoint of the study was the composite of death or need of reintervention.

Results
A total of 98 patients (54 with no residual MR-Group 1, and 44 with less than moderate residual MR-Group 2) were analyzed. Of these, 72% presented with New York Heart Association (NYHA) 3/4, and 38% were women. The primary endpoint of the study occurred in 3 (5.5%) patients in Group 1 and 6 (13.6%) patients in Group 2 MR (P = 0.31). There was a trend toward a higher incidence of use of inotropic drugs post-interventional (P = 0.12), and a longer hospital stay among patients with less than moderate residual MR (P = 0.18).

Conclusion
In our study population, patients with less than moderate residual MR had a trend toward a higher risk of early adverse outcomes as compared with patients with no residual MR by post-pump TEE. Studies with a larger patient population and longer follow-up data may be useful to better define the clinical significance of residual mild MR after mitral vale repair.

Background
Mitral regurgitation is the most commonly encountered valve lesion in modern clinical practice 1. As echocardiography is the most widely available cardiac imaging modality, it is the technique which is routinely used to assess patients with suspected or known MR. Echo-Doppler is an excellent technique for detecting the presence of MR and defining the underlying pathological cause 2. Echo-Doppler grading of regurgitation severity in conjunction with patient symptoms and signs and occasionally invasive haemodynamic information are useful in the decision-making process with respect to the need for and timing of mitral valve surgery 2.

It is important to note that mitral regurgitation changed in the last decades with regard to its etiologic profile, which is now dominated by degenerative and ischemic causes in developed countries 3; to its noninvasive assessment with the developments in transesophageal echocardiography (TEE), colour flow imaging, and new methods of quantization of regurgitation 1; and to its management with improved understanding of the role of left ventricle (LV) function in prognosis 2. Most importantly, advances in conservative surgery have improved its treatment 4.

The post-Cardiac Pulmonary Bypass (CPB) TEE exam is essential in helping to determine the competency of the repaired mitral valve (MV), and to evaluate persistent MR 5. Hemodynamic loading conditions and left ventricle function also must be taken into consideration in the assessment of residual MR 6. Following MV procedures, several studies have suggested that, in approximately 5├óÔé¼ÔÇ£11% of cases the post-CPB TEE exam may identify persistent lesions that require additional immediate surgical intervention 7,8. Moderate to severe residual MR will necessitate a return to CPB for further evaluation and repeat surgery.

The aim of the present retrospective study was to assess the short-term outcome of patients who underwent mitral valve repair in our Cardiac Surgery Division with less than moderate mitral regurgitation after repair.

MethodsData source
To collect the necessary information for this study we used the database of patients admitted and treated at Ospedale Pasquinucci, IFC-CNR, Massa, Italy from January 2004 to October 2005./>/>/>/>/>/>/>/>/>/>/>/>/>/>/>/>/>/>/>

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References
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