Abstract 19635: Anteroposterior Diameter of the Mitral Valve is Associated With Residual Mitral Regurgitation After Isolated Aortic Valve Surgery

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Abstract

Introduction: Functional mitral regurgitation (MR) complicated with severe aortic stenosis (AS) is in general reversed after aortic valve replacement (AVR), while residual MR post-AVR is associated with poor clinical outcome, suggesting that the pressure overload may not be a sole cause of functional MR. We herein hypothesized that geometry of the mitral complex including left ventricle (LV) may be related to functional MR in severe AS.

Methods: Between 2011 and 2016, this study enrolled 35 patients who underwent isolated aortic valve surgery including TAVI for AS complicated with moderate functional MR and were examined by 64-slice computed tomography (CT) scanning study before isolated AVR. The cohort was divided into the following 2 groups; 23 patients having mild or less residual MR (group A) and 12 patients having moderate residual MR (group B).

Results: The mean age was 86.3 ± 3.7 vs 82.6 ± 5.0 years (P =0.17), body mass index was 20.9 ± 4.1 vs 18.3 ± 1.7 m2 (P = 0.71), and Euroscore was 26.1 ± 10.1 vs 19.9 ± 5.86 (P = 0.66), respectively. In addition, ejection fraction (60.8 ± 16.3% vs 67.6 ± 11.5%, P = 0.26), aortic valve area (0.56 ± 0.13 vs 0.56 ± 0.13 cm2, P = 0.90), mean pressure gradient (56.5 ±22.3 vs 50.9 ± 7.1 mmHg, P = 0.30), or peak velocity (4.7± 0.8 vs 4.5 ± 0.3 m/s, P = 0.37) were not significantly different between the two groups on echocardiography. In the CT study, anteroposterior diameter of the mitral valve was significantly smaller in the mild or less group than that in the Moderate group (24.3 ± 1.4 mm vs 27.7 ± 3.7 mm, P < 0.05). In contrast, area of the mitral valve (943 ± 97 vs 1069 ± 238 cm2, P = 0.18), tenting height (8.6 ± 2.1 vs 8.2 ± 1.5 mm, P = 0.59), or long axis length of the LV (78.1 ± 7.1 mm vs 81.4 ± 7.4 mm, P = 0.35) were not significantly different between the two groups. AUC of 0.79 and cut-off value of 26.0mm were obtained from ROC curve, respectively. Moreover, Fisher’s exact test showed those who had 26.0mm or more of anteroposterior diameter were significantly associated with residual MR (p = 0.002).

Conclusions: Anteroposterior diameter of the mitral valve was associated with residual MR. Geometrical analysis may be useful in determining surgical indication for functional MR at the time of AVR.

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