Determinants of functional capacity after mitral valve annuloplasty or replacement for ischemic mitral regurgitation

J Thorac Cardiovasc Surg. 2015 Jun;149(6):1595-603. doi: 10.1016/j.jtcvs.2015.03.003. Epub 2015 Mar 11.

Abstract

Objective: To identify the exercise echocardiographic determinants of long-term functional capacity, in patients with chronic ischemic mitral regurgitation, after restrictive mitral valve annuloplasty (RMA) or mitral valve replacement (MVR).

Methods: We retrospectively analyzed 121 patients with significant chronic ischemic mitral regurgitation, who underwent RMA (n = 62) or MVR (n = 59), between 2005 and 2011. Preoperatively, all patients underwent a resting echocardiographic examination, and a 6-minute walking test (6-MWT) to measure distance. Resting and exercise stress echocardiography, and the 6-MWT were repeated at 41 ± 16.5 months.

Results: After surgery, the 6-MWT distance significantly improved in the MVR group, and decreased in the RMA group (+37 ± 39 m vs -24 ± 49 m, respectively; P < .0001). Exercise indexed effective orifice area was significantly higher in the MVR, versus the RMA, group (MVR: change from 1.3 ± 0.2 cm(2)/m(2) to 1.5 ± 0.3 cm(2)/m(2); RMA: change from 1.1 ± 0.3 cm(2)/m(2) to 1.2 ± 0.3 cm(2)/m(2); P = .001). The mean mitral gradients significantly increased from rest to exercise, in both groups, but to a greater extent in the RMA group (change from 4.4 ± 1.4 to 11 ± 3.6 mm Hg; MVR: change from 4.3 ± 1.8 to 9 ± 3.5 mm Hg; P = .006). On multivariate analysis, MVR and exercise indexed effective orifice area were the main independent determinants of postoperative 6-MWT. In the RMA group, 25 patients experienced late mitral regurgitation recurrence, severe in 9 (14%) of them. The rate of postoperative cardiovascular events was significantly higher in the RMA group (21% vs MVR: 8%; P = .03). Follow-up survival was 83% in the RMA group and 88% in the MVR group (P = .54).

Conclusions: For chronic ischemic mitral regurgitation, MVR versus RMA was associated with better postoperative exercise hemodynamic performance and long-term functional capacity.

Keywords: Chronic ischemic mitral regurgitation; echocardiography; exercise; functional capacity; mitral valve surgery.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Chronic Disease
  • Echocardiography, Doppler
  • Echocardiography, Stress
  • Exercise Test
  • Exercise Tolerance*
  • Female
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Hemodynamics*
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve / diagnostic imaging
  • Mitral Valve / physiopathology
  • Mitral Valve / surgery*
  • Mitral Valve Annuloplasty* / adverse effects
  • Mitral Valve Insufficiency / diagnosis
  • Mitral Valve Insufficiency / etiology
  • Mitral Valve Insufficiency / physiopathology
  • Mitral Valve Insufficiency / surgery*
  • Myocardial Ischemia / complications*
  • Myocardial Ischemia / diagnosis
  • Myocardial Ischemia / physiopathology
  • Predictive Value of Tests
  • Recovery of Function
  • Recurrence
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • Walking