Exercise Hemodynamic and Functional Capacity After Mitral Valve Replacement in Patients With Ischemic Mitral Regurgitation: A Comparison of Mechanical Versus Biological Prostheses

Carlo Fino, Attilio Iacovoni, Philippe Pibarot, John R Pepper, Paolo Ferrero, Maurizio Merlo, Lorenzo Galletti, Massimo Caputo, Paolo Ferrazzi, Constantinos Anagnostopoulos, Diego Cugola, Michele Senni, Diego Bellavia, Julien Magne

Research output: Contribution to journalArticle

Abstract

BACKGROUND: In patients with ischemic mitral regurgitation requiring mitral valve replacement (MVR), the choice of the prosthesis type is crucial. The exercise hemodynamic and functional capacity performance in patients with contemporary prostheses have never been investigated. To compare exercise hemodynamic and functional capacity between biological (MVRb) and mechanical (MVRm) prostheses.

METHODS AND RESULTS: We analyzed 86 consecutive patients with ischemic mitral regurgitation who underwent MVRb (n=41) or MVRm (n=45) and coronary artery bypass grafting. All patients underwent preoperative resting echocardiography and 6-minute walking test. At follow-up, exercise stress echocardiography was performed, and the 6-minute walking test was repeated. Resting and exercise indexed effective orifice areas of MVRm were larger when compared with MVRb (resting: 1.30±0.2 versus 1.19±0.3 cm2/m2; P=0.03; exercise: 1.57±0.2 versus 1.18±0.3 cm2/m2; P=0.0001). The MVRm had lower exercise systolic pulmonary arterial pressure at follow-up compared with MVRb (41±5 versus 59±7 mm Hg; P=0.0001). Six-minute walking test distance was improved in the MVRm (pre-operative: 242±43, post-operative: 290±50 m; P=0.001), whereas it remained similar in the MVRb (pre-operative: 250±40, post-operative: 220±44 m; P=0.13). In multivariable analysis, type of prosthesis, exercise indexed effective orifice area, and systolic pulmonary arterial pressure were joint predictors of change in 6-minute walking test (ie, difference between baseline and follow-up).

CONCLUSIONS: In patients with ischemic mitral regurgitation, bioprostheses are associated with worse hemodynamic performance and reduced functional capacity, when compared with MVRm. Randomized studies with longer follow-up including quality of life and survival data are required to confirm these results.

Original languageEnglish
Pages (from-to)e004056
JournalCirculation. Heart failure
Volume11
Issue number1
DOIs
Publication statusPublished - Jan 2018

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Mitral Valve Insufficiency
Mitral Valve
Prostheses and Implants
Hemodynamics
Exercise
Walking
Arterial Pressure
Bioprosthesis
Stress Echocardiography
Lung
Coronary Artery Bypass
Echocardiography
Joints
Quality of Life
Survival

Keywords

  • Journal Article

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Exercise Hemodynamic and Functional Capacity After Mitral Valve Replacement in Patients With Ischemic Mitral Regurgitation : A Comparison of Mechanical Versus Biological Prostheses. / Fino, Carlo; Iacovoni, Attilio; Pibarot, Philippe; Pepper, John R; Ferrero, Paolo; Merlo, Maurizio; Galletti, Lorenzo; Caputo, Massimo; Ferrazzi, Paolo; Anagnostopoulos, Constantinos; Cugola, Diego; Senni, Michele; Bellavia, Diego; Magne, Julien.

In: Circulation. Heart failure, Vol. 11, No. 1, 01.2018, p. e004056.

Research output: Contribution to journalArticle

Fino, C, Iacovoni, A, Pibarot, P, Pepper, JR, Ferrero, P, Merlo, M, Galletti, L, Caputo, M, Ferrazzi, P, Anagnostopoulos, C, Cugola, D, Senni, M, Bellavia, D & Magne, J 2018, 'Exercise Hemodynamic and Functional Capacity After Mitral Valve Replacement in Patients With Ischemic Mitral Regurgitation: A Comparison of Mechanical Versus Biological Prostheses', Circulation. Heart failure, vol. 11, no. 1, pp. e004056. https://doi.org/10.1161/CIRCHEARTFAILURE.117.004056
Fino, Carlo ; Iacovoni, Attilio ; Pibarot, Philippe ; Pepper, John R ; Ferrero, Paolo ; Merlo, Maurizio ; Galletti, Lorenzo ; Caputo, Massimo ; Ferrazzi, Paolo ; Anagnostopoulos, Constantinos ; Cugola, Diego ; Senni, Michele ; Bellavia, Diego ; Magne, Julien. / Exercise Hemodynamic and Functional Capacity After Mitral Valve Replacement in Patients With Ischemic Mitral Regurgitation : A Comparison of Mechanical Versus Biological Prostheses. In: Circulation. Heart failure. 2018 ; Vol. 11, No. 1. pp. e004056.
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T1 - Exercise Hemodynamic and Functional Capacity After Mitral Valve Replacement in Patients With Ischemic Mitral Regurgitation

T2 - A Comparison of Mechanical Versus Biological Prostheses

AU - Fino, Carlo

AU - Iacovoni, Attilio

AU - Pibarot, Philippe

AU - Pepper, John R

AU - Ferrero, Paolo

AU - Merlo, Maurizio

AU - Galletti, Lorenzo

AU - Caputo, Massimo

AU - Ferrazzi, Paolo

AU - Anagnostopoulos, Constantinos

AU - Cugola, Diego

AU - Senni, Michele

AU - Bellavia, Diego

AU - Magne, Julien

N1 - © 2018 American Heart Association, Inc.

PY - 2018/1

Y1 - 2018/1

N2 - BACKGROUND: In patients with ischemic mitral regurgitation requiring mitral valve replacement (MVR), the choice of the prosthesis type is crucial. The exercise hemodynamic and functional capacity performance in patients with contemporary prostheses have never been investigated. To compare exercise hemodynamic and functional capacity between biological (MVRb) and mechanical (MVRm) prostheses.METHODS AND RESULTS: We analyzed 86 consecutive patients with ischemic mitral regurgitation who underwent MVRb (n=41) or MVRm (n=45) and coronary artery bypass grafting. All patients underwent preoperative resting echocardiography and 6-minute walking test. At follow-up, exercise stress echocardiography was performed, and the 6-minute walking test was repeated. Resting and exercise indexed effective orifice areas of MVRm were larger when compared with MVRb (resting: 1.30±0.2 versus 1.19±0.3 cm2/m2; P=0.03; exercise: 1.57±0.2 versus 1.18±0.3 cm2/m2; P=0.0001). The MVRm had lower exercise systolic pulmonary arterial pressure at follow-up compared with MVRb (41±5 versus 59±7 mm Hg; P=0.0001). Six-minute walking test distance was improved in the MVRm (pre-operative: 242±43, post-operative: 290±50 m; P=0.001), whereas it remained similar in the MVRb (pre-operative: 250±40, post-operative: 220±44 m; P=0.13). In multivariable analysis, type of prosthesis, exercise indexed effective orifice area, and systolic pulmonary arterial pressure were joint predictors of change in 6-minute walking test (ie, difference between baseline and follow-up).CONCLUSIONS: In patients with ischemic mitral regurgitation, bioprostheses are associated with worse hemodynamic performance and reduced functional capacity, when compared with MVRm. Randomized studies with longer follow-up including quality of life and survival data are required to confirm these results.

AB - BACKGROUND: In patients with ischemic mitral regurgitation requiring mitral valve replacement (MVR), the choice of the prosthesis type is crucial. The exercise hemodynamic and functional capacity performance in patients with contemporary prostheses have never been investigated. To compare exercise hemodynamic and functional capacity between biological (MVRb) and mechanical (MVRm) prostheses.METHODS AND RESULTS: We analyzed 86 consecutive patients with ischemic mitral regurgitation who underwent MVRb (n=41) or MVRm (n=45) and coronary artery bypass grafting. All patients underwent preoperative resting echocardiography and 6-minute walking test. At follow-up, exercise stress echocardiography was performed, and the 6-minute walking test was repeated. Resting and exercise indexed effective orifice areas of MVRm were larger when compared with MVRb (resting: 1.30±0.2 versus 1.19±0.3 cm2/m2; P=0.03; exercise: 1.57±0.2 versus 1.18±0.3 cm2/m2; P=0.0001). The MVRm had lower exercise systolic pulmonary arterial pressure at follow-up compared with MVRb (41±5 versus 59±7 mm Hg; P=0.0001). Six-minute walking test distance was improved in the MVRm (pre-operative: 242±43, post-operative: 290±50 m; P=0.001), whereas it remained similar in the MVRb (pre-operative: 250±40, post-operative: 220±44 m; P=0.13). In multivariable analysis, type of prosthesis, exercise indexed effective orifice area, and systolic pulmonary arterial pressure were joint predictors of change in 6-minute walking test (ie, difference between baseline and follow-up).CONCLUSIONS: In patients with ischemic mitral regurgitation, bioprostheses are associated with worse hemodynamic performance and reduced functional capacity, when compared with MVRm. Randomized studies with longer follow-up including quality of life and survival data are required to confirm these results.

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DO - 10.1161/CIRCHEARTFAILURE.117.004056

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JO - Circulation: Heart Failure

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