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. 2021 Feb 20;27(1):32-40.
doi: 10.5761/atcs.oa.20-00035. Epub 2020 Jun 10.

Clinical Outcomes of a Customized Mitral Valve Plasty for Functional Mitral Regurgitation with a Low Ejection Fraction and Implications for Preoperative Right Ventricular Function

Koji Furukawa  1   2 , Mitsuhiro Yano  1 , Hirohito Ishii  2 , Shuhei Sakaguchi  2 , Kousuke Mori  2 , Masanori Nishimura  1 , Kunihide Nakamura  2
Affiliations

Clinical Outcomes of a Customized Mitral Valve Plasty for Functional Mitral Regurgitation with a Low Ejection Fraction and Implications for Preoperative Right Ventricular Function

Koji Furukawa et al. Ann Thorac Cardiovasc Surg. .

Abstract

Purpose: To evaluate clinical outcomes of customized mitral valve plasty (MVP) for the treatment of functional mitral regurgitation (FMR) with a low ejection fraction (EF) and to determine which preoperative factors affected the clinical outcome.

Methods and results: MVP was adjusted according to the degree of left ventricle (LV) remodeling. We performed mitral annuloplasty (MAP) alone in 14 patients and added subvalvular procedures (SVPs) in 22 patients at a high risk of recurrent MR. During follow-up, reverse LV remodeling was obtained and the 3-year and 5-year non-recurrence rates of MR grade ≥2 were 94% and 89%, respectively. Two patients died during their hospital stay, and four more patients died of cardiac causes during follow-up. The 3-year and 5-year rates of freedom from cardiac-related mortality were 86% and 81%, respectively; no significant difference was observed between the two treatment groups. Right ventricular fractional area change (RVFAC) was a significant predictor of cardiac mortality. Patients with an RVFAC of <26% had significantly poorer cardiac-related mortality (71% at 3 years) than those with an RVFAC of ≥26% (95% at 3 years).

Conclusion: Customized MVP provided durable mitral competence and reverse LV remodeling. Preoperative RV function was associated with cardiac-related mortality.

Keywords: RVFAC; functional mitral regurgitation; mitral valve plasty; right ventricular function; subvalvular procedure.

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Figures

Fig. 1
Fig. 1. The survival curve for cardiac-related mortality. (A) The 3-year and 5-year rates of freedom from cardiac-related mortality for all patients were 86% and 81%, respectively. (B) The 3-year and 5-year rates of freedom from cardiac-related mortality in the MAP group were 93% and 93%, respectively, and those in the SVP group were 81% and 74%, respectively (p = 0.3). MAP: mitral annuloplasty; SVP: subvalvular procedure
Fig. 2
Fig. 2. The survival curve for cardiac-related mortality in patients with preoperative RVFAC of ≥26% and <26%. The 3-year and 5-year rates of freedom from cardiac-related mortality in patients with RVFAC of ≥26% were 95% and 95%, respectively, and that in patients with RVFAC of <26% were 71% and 59%, respectively (p = 0.03). RVFAC, right ventricular fractional area change
See this image and copyright information in PMC

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