Impact of type and size of annuloplasty prosthesis on hemodynamic status after mitral valve repair for degenerative disease

Abstract

Objective: The aim of this study is to evaluate mitral valve hemodynamics after mitral valve repair for degenerative disease, and seek the impact of type/size of annuloplasty prosthesis on resting cardiac hemodynamics. Methods: Between October 2012 and June 2019, 301 patients underwent isolated mitral valve repair for degenerative disease were enrolled. Correlation between postoperative mitral hemodynamics and type/size of annuloplasty prosthesis was evaluated. Results: There were significant correlations between annuloplasty size and peak velocity (r = −0.41, p < 0.001), peak transmitral pressure gradient (TMPG) (r = −0.40, p < 0.001), mean TMPG (r = −0.41, p < 0.001), effective orifice area (EOA) (r = 0.26, p < 0.001), and pulmonary artery systolic pressure (r = −0.15, p = 0.010). In patients with larger annuloplasty prostheses (≥30 mm), the type of annuloplasty prosthesis (band or ring) did not influence the mitral hemodynamics, however, mean TMPG was significantly greater in patients with a full ring (2.9 mmHg [2.1–3.7] vs. 4.0 mmHg [2.8–5.0], p < 0.001) in patients with smaller annuloplasty (<30 mm). Left ventricular ejection fraction and stroke volume were significantly associated with an increase of TMPG (r = 0.14, p = 0.016 and r = 0.24, p < 0.001). Conclusions: A larger partial band had the potential to improve mitral hemodynamics after mitral repair for degenerative disease. However, echocardiographic mitral hemodynamics was influenced by LV function. Therefore, a more accurate method is required to elucidate the true impact of mitral repair on hemodynamics.

Keywords

• Mitral valve repair
• Degenerative disease
• Hemodynamics
• Functional mitral stenosis