Adult: Mitral ValveLeft ventricle–mitral valve ring size mismatch following ring annuloplasty for nonischemic dilated cardiomyopathy
Graphical abstract
In patients with nonischemic dilated cardiomyopathy who undergo mitral annuloplasty, the ratio of left ventricular end-systolic dimension to mitral valve ring size is independently associated with postoperative recurrent mitral regurgitation.
Section snippets
Patients
We examined patients with functional MR secondary to nonischemic DCM (LV ejection fraction [LVEF] ≤40%) who underwent an RMA procedure between 2003 and 2014 and who had a complete transthoracic echocardiography study at 6 months postsurgery. All patients had LV systolic dysfunction and dilation, as well as functional moderate or severe MR caused by restricted leaflet closure (Carpentier type IIIb). Patients with degenerative MV disease and those who underwent surgical ventricular restoration
Patient Characteristics
In our surgical database, 66 patients (mean age, 63 ± 10 years) met the inclusion criteria and were included in this study. The mean body surface area was 1.6 ± 0.2 m2, and the mean size of the implanted ring was 26 ± 1 mm (range, 24-30 mm). Consequently, the mean LVESD/ring size ratio was 2.4 ± 0.4.
Notably, the size of the prosthetic mitral ring implanted during RMA was positively correlated with the patient's body surface area (ρ = 0.243; P = .049). On the other hand, neither LVEDD
Discussion
The major findings of this study can be summarized as follows: (1) in a specific cohort of patients with advanced nonischemic cardiomyopathy undergoing an RMA procedure, the LVESD/ring size ratio was significantly associated with mild or greater recurrent MR at postoperative 6 months (Figure 3); (2) in patients with an LVESD/ring size ratio >2.42 (the mismatch group), the cutoff value determined for predicting recurrent MR in the ROC analysis, had a lower survival rate compared with patients
Conclusions
In our cohort, the LV–MV ring size mismatch ratio was significantly associated with postoperative mild or greater recurrent MR in patients with functional nonischemic MR undergoing RMA. These findings may aid patient selection for MV surgery, as well as the development of surgical strategies for nonischemic DCM.
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Collaborators in the OSCAR Study Group: Yasushi Yoshikawa, MD, PhD, Hiroki Hata, MD, PhD, Takuji Kawamura, MD, PhD, Ai Kawamura, MD, PhD, Takayoshi Ueno, MD, PhD, and Toru Kuratani, MD, PhD, all from the Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, and Junya Sado, MPH, PhD, from the Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine.