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Baseline characteristics predict recurrence after repair for severe ischemic MR
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TORONTO — Models constructed using routine baseline characteristics provided good determinants of patient survival and recurrence of mitral regurgitation after repair for severe ischemic mitral regurgitation, researchers reported at the American Association for Thoracic Surgery Annual Meeting.
“We know that even with excellent repair of the valve, it can continue to leak,” Irving Kron, MD, past president of the AATS and chair of the department of surgery at University of Virginia Health System, told Cardiology Today. “We want to be able to predict ahead of time which [valves] can be repaired without the risk for leakage. We want to be able to know which patients will do best [with repair].”
Recent data from the Cardiothoracic Surgical Trials Network demonstrated no difference in left ventricular end-systolic volume index at 1 year between patients with severe ischemic mitral regurgitation (MR) who were randomly assigned to mitral valve repair compared with mitral valve replacement. This finding prompted Kron and colleagues to identify characteristics that could portend recurrent MR in patients who undergo mitral valve repair, either with a downsized complete rigid ring or semi-rigid ring.
The researchers analyzed 13 routine echocardiographic characteristics, including tenting area and length/leaflet angles as measures of tethering, and five clinical characteristics, including age and presence of basal aneurysm collected at baseline, to determine whether they could discriminate between patients who would and would not experience recurrent MR or death, according to the study abstract.
For the current analysis of 99 patients who received mitral valve repair, the researchers classified MR recurrence and death out to 2 years and as of March 2014. In total, 61 patients experienced recurrence of moderate and/or severe MR or died during follow-up.
Receiver operator characteristic curves were obtained to determine the probability of MR recurrence or death. Use of the 18 echocardiographic and clinical characteristics yielded an area under the receiver operating characteristic curve (AUC) of 0.83. When the researchers narrowed possible predictors down to five variables — age, NYHA class, degree of MR by vena contracta and effective orifice area, and presence of basal aneurysm — it yielded an AUC of 0.76.
“This is a sophisticated technique that will allow us to predict who you can repair and who you can replace,” Kron said in an interview.
The presence or absence of basal aneurysm will be a key factor in determining the form of intervention in patients who have had a valve implanted, Kron said.
“Patients with basal aneurysms are different,” he said, noting the absence of a basal aneurysm means a patient will likely undergo valve replacement.
The 2-year follow-up data also showed that most patients who experienced valve leakage did not have worse outcomes with time, according to Kron.
“Almost all repair issues were moderate, and they did not progress with time,” he said. – by Louise Gagnon
For more information:
Kron I. LB2: Late-breaking clinical trial. Predicting recurrence of mitral regurgitation following repair for surgical ischemic MR. Presented at: American Association for Thoracic Surgery Annual Meeting; April 26-30, 2014; Toronto.
Disclosure: Kron reports no relevant financial disclosures.