Successful surgical treatment of chronic ischemic mitral regurgitation achieves left ventricular reverse remodeling but does not affect right ventricular function

Abstract

Effective restrictive mitral annuloplasty induces reverse left ventricular remodeling. Absence of recurrent chronic ischemic mitral regurgitation improves tricuspid insufficiency grading, systolic pulmonary arterial pressure, right ventricular ejection fraction, tricuspid annular plane systolic excursion, New York Heart Association, and diuretic need in patients who do not undergo tricuspid surgery, but only tricuspid insufficiency grading, New York Heart Association, and daily diuretic need in patients who undergo tricuspid surgery.

Impact of increased transmitral gradients after undersized annuloplasty for chronic ischemic mitral regurgitation

“…Saphenous veins (SV) were always harvested from the best side, as detected by preoperative echo-Doppler scanning. All CABG routinely underwent intraoperative transit-time analysis to assess the quality of each graft [4]. The mitral valve was exposed through a longitudinal atriotomy along the Waterston's groove in all patients.…”

“…The mitral valve was exposed through a longitudinal atriotomy along the Waterston's groove in all patients. Ring size (Carpentier-Edwards Physio ring; Edwards Lifesciences, Irvine, CA, USA or Carpentier-McCarthy-Adams ring; Edwards Lifesciences, Irvine, CA, USA) was determined after careful measurement of the height of the anterior leaflet and inter-trigonal distance, and then downsizing by two sizes [4]. Complete symmetric rings (Carpentier-Edwards Physio ring) were preferred when CIMR was predominantly due to annular dilation (Carpentier type I), and complete asymmetric rings (Carpentier-McCarthy-Adams ring) when inferior or postero-lateral infarction caused restrictive systolic leaflet motion (Carpentier type IIIb).…”

“…Mean preoperative CIMR was 3.5 ± 0.5 (range 2+ to 4+). Indexed left ventricular mass was calculated as already reported [4]. TI was evaluated using the apical 4-chamber view.…”

“…However, despite the demonstration of beneficial effects on diverse echocardiographic parameters and functional class [1][2][3][4], a recent paper by Magne and coworkers has evidenced the potential risk of an iatrogenic mitral stenosis after URMA for CIMR [5]. On the other hand, another study from the Duke University demonstrated that despite the effect of a well-tolerated increase of trans-mitral gradients, URMA plus CABG led to a durable correction of CIMR [6].…”

Current transcatheter devices to treat functional tricuspid regurgitation with discussion of issues relevant to clinical trial design

“…Recognizing the need for early surgical intervention may be difficult for a number of reasons: the underestimation of TR severity under anesthesia (11); the misconception that TR resolves following mitral valve surgery (12,13); the overestimation of surgical risk when concomitant tricuspid valve surgery is performed at the time of mitral valve surgery (14,15); and the under-appreciation of long-term RV function improvement following correction of TR (16,17). Of note, recent studies show that tricuspid valve surgery combined with left heart surgery is not associated with a significant increase in mortality (18), however, re-operative mortality remains high (19).…”