Prognostic value of mitral valve tenting area in patients with functional mitral regurgitation

Abstract

OBJECTIVES Mitral valve (MV) repair in functional mitral regurgitation is still associated with suboptimal outcomes. Our goal was to determine whether the clinical outcome following MV repair correlates with preoperative tenting parameters. METHODS We retrospectively identified consecutive patients with functional mitral regurgitation who underwent an isolated MV annuloplasty during a 7-year period (2010–2016) from our institutional database. Preoperative tenting parameters (i.e. tenting height, coaptation length, tenting area, posterior mitral leaflet and anterior mitral leaflet angles and interpapillary muscle distance) were systematically measured. The primary end point was the composite of survival and freedom from adverse cardiac events. The follow-up protocol consisted of a structured clinical questionnaire and an analysis of the echocardiographic data. RESULTS A total of 240 patients (mean age 67.8 ± 9.8 years, 57% of men) were analysed. The overall 5-year survival rate for the whole study cohort was 74.7 ± 4.2%, and freedom from adverse cardiac events was 84.8 ± 3.4%. A tenting area ≥2.4 cm2 was identified as a cut-off value, independently predicting the composite primary study end point (hazard ratio 2.0; P = 0.03). Furthermore, a Kaplan–Meier analysis revealed a strong tendency towards worse 5-year outcomes in patients with a tenting area ≥2.4 cm2 (n = 153) versus patients with a tenting area <2.4 cm2 (n = 87) (65.3 ± 5.5% vs 77.1 ± 6.3%; P = 0.06). CONCLUSIONS MV annuloplasty is associated with acceptable clinical and echocardiographic outcomes in patients with functional mitral regurgitation 5 years postoperatively. A preoperative tenting area ≥2.4 cm2 showed a strong trend towards a worse 5-year survival rate and an increased risk of adverse cardiac events after an isolated MV annuloplasty.

Predicting clinical outcome by indexed mitral valve tenting in functional mitral valve regurgitation

“…Our preliminary study showed that nonindexed MV tenting area >2.4 cm 2 was associated with a worse prognosis in patients with FMR following MV repair (HR 2.1; p=0.03). 5 Other researchers investigated also the prognostic value of non-indexed MV tenting area in FMR and found that the cut-off value of MV tenting area predicting adverse clinical outcomes ranged from 2.5 to 3.4 cm 2 (table 4). [6][7][8][9] Moreover, recommendations of European Association of Echocardiography defined non-indexed tenting area >2.5 cm 2 as a risk factor for recurrent MR following MV repair in FMR.…”

“…Preliminary results with a limited follow-up had been previously published by our group. 5 Individual patient consent was waived. Patients or public were not involved in our study design.…”

“…3 4 Severity of MV tenting has been shown to correlate with prognosis of patients with FMR. [5][6][7][8][9] Recurrent mitral regurgitation (MR), heart failure and death occurred more often in patients with FMR with a preoperative MV tenting area >2.5 cm 2 . [5][6][7][8][9] Though, it is difficult…”