Abstract
Funding Acknowledgements
Department funding
Background
Mitral valve repair is preferred to valve replacement in cases of degenerative mitral regurgitation (MR) due to the lower risk of valve-related complications and operative mortality. In mitral valve repair, annuloplasty is associated with better clinical outcomes. Sizing of the annuloplasty ring with a ring sizer, which should be performed in the end-systolic phase, is performed in diastole during hyperkalaemia cardioplegic arrest. Three-dimensional transoesophageal echocardiography (3D-TEE) allows measurement of the mitral valve while the heart is beating, which is beneficial since the mitral valve size changes throughout the cardiac cycle.
Purpose
To investigate whether 3D-TEE measurements of the mitral valve are effective for preventing recurrent mitral regurgitation (MR) in patients who undergo mitral valve repair for degenerative MR.
Methods
This study retrospectively reviewed 139 patients who underwent mitral annuloplasty for degenerative MR. After 47 patients were excluded, 92 patients were analysed. The inter-commissural (IC) distance and anterior leaflet height of the A2 segment of the mitral valve were measured by 3D-TEE at the end-systolic phase. The annuloplasty ring size and type were selected by surgeons using specific ring sizers. We investigated the association of the IC distance with the size of implanted annulus ring and differences between the size of implanted annulus ring and the IC distance. We also compared the IC distance, the A2 height, and the ratio of A2 height to IC distance between patients with and without recurrent mild-to-moderate MR for 36 months.
Results
There was a significant correlation between the size of the mitral annuloplasty ring and the IC distance (R²=0.7023, p < 0.001). The variety between implanted annulus ring size and IC distance measured by 3D-TEE was shown in Figure1. Eight cases had mild or greater recurrent MR. There was a significant difference in the ratio of A2 height to IC distance between patients with and without recurrent MR (p = 0.006). The A2 height was greater in patients with recurrent MR, but this difference was not significant (p = 0.059).
Conclusions
There was a significant correlation between the size of the mitral annuloplasty ring and the IC distance. Our results demonstrated a higher ratio of A2 height to IC distance in patients with recurrent MR.
Abstract P1409 Figure1
Prediction of the annuloplasty ring size in patients undergoing mitral valve repair using real-time three-dimensional transoesophageal echocardiography