Impact of preoperative anterior leaflet tethering on the recurrence of ischemic mitral regurgitation and the lack of left ventricular reverse remodeling after restrictive annuloplasty

Sandro Gelsomino, Leen Van Garsse, Fabiana Luc, Roberto Lorusso, Emile Cheriex, Carmelo Massimiliano Rao, Sabina Caciolli, Enrico Vizzardi, Elena Crudeli, Pierluigi Stefno, Gian Franco Gensini, Jos Maessen

Research output: Contribution to journalArticle

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Abstract

Background: The aim of this multicenter study was to investigate the impact of the preoperative anterior mitral leaflet tethering angle, α′, on the recurrence of mitral regurgitation (MR) and left ventricular (LV) reverse remodeling (LVRR) after undersized mitral ring annuloplasty. Methods: The study population consisted of 362 patients, who were divided into two groups by baseline α′: group 1, α′ <39.5° (n = 196), and group 2, α′ ≥ 39.5° (n = 166). End points were recurrent MR ≥ 2+; LVRR, defined as a reduction in end-systolic volume index > 15%; and LV geometric reverse remodeling, defined as a reduction in systolic sphericity index to a normal value of .05). When we allowed for interactions between α′ and other risk factors, this effect occurred also in low-risk subgroups, and it was equivalent or generally attenuated in higher risk patients. There were no significant interactions between α′ and any of the covariates (all P values >.05). Conclusions: Anterior mitral leaflet tethering is a powerful predictor of MR recurrence and lack of LVRR after undersized mitral ring annuloplasty. Evaluation of leaflet tethering should be incorporated into clinical risk assessment and prediction models.

Original languageEnglish
Pages (from-to)1365-1375
Number of pages11
JournalJournal of the American Society of Echocardiography
Volume24
Issue number12
DOIs
Publication statusPublished - Dec 2011

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Mitral Valve Annuloplasty
Ventricular Remodeling
Mitral Valve Insufficiency
Recurrence
Multicenter Studies
Reference Values
Population

Keywords

  • Coronary artery bypass grafts
  • Mitral valve
  • Myocardial infarction

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Impact of preoperative anterior leaflet tethering on the recurrence of ischemic mitral regurgitation and the lack of left ventricular reverse remodeling after restrictive annuloplasty. / Gelsomino, Sandro; Van Garsse, Leen; Luc, Fabiana; Lorusso, Roberto; Cheriex, Emile; Rao, Carmelo Massimiliano; Caciolli, Sabina; Vizzardi, Enrico; Crudeli, Elena; Stefno, Pierluigi; Gensini, Gian Franco; Maessen, Jos.

In: Journal of the American Society of Echocardiography, Vol. 24, No. 12, 12.2011, p. 1365-1375.

Research output: Contribution to journalArticle

Gelsomino, S, Van Garsse, L, Luc, F, Lorusso, R, Cheriex, E, Rao, CM, Caciolli, S, Vizzardi, E, Crudeli, E, Stefno, P, Gensini, GF & Maessen, J 2011, 'Impact of preoperative anterior leaflet tethering on the recurrence of ischemic mitral regurgitation and the lack of left ventricular reverse remodeling after restrictive annuloplasty', Journal of the American Society of Echocardiography, vol. 24, no. 12, pp. 1365-1375. https://doi.org/10.1016/j.echo.2011.09.015
Gelsomino, Sandro ; Van Garsse, Leen ; Luc, Fabiana ; Lorusso, Roberto ; Cheriex, Emile ; Rao, Carmelo Massimiliano ; Caciolli, Sabina ; Vizzardi, Enrico ; Crudeli, Elena ; Stefno, Pierluigi ; Gensini, Gian Franco ; Maessen, Jos. / Impact of preoperative anterior leaflet tethering on the recurrence of ischemic mitral regurgitation and the lack of left ventricular reverse remodeling after restrictive annuloplasty. In: Journal of the American Society of Echocardiography. 2011 ; Vol. 24, No. 12. pp. 1365-1375.
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AU - Luc, Fabiana

AU - Lorusso, Roberto

AU - Cheriex, Emile

AU - Rao, Carmelo Massimiliano

AU - Caciolli, Sabina

AU - Vizzardi, Enrico

AU - Crudeli, Elena

AU - Stefno, Pierluigi

AU - Gensini, Gian Franco

AU - Maessen, Jos

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AB - Background: The aim of this multicenter study was to investigate the impact of the preoperative anterior mitral leaflet tethering angle, α′, on the recurrence of mitral regurgitation (MR) and left ventricular (LV) reverse remodeling (LVRR) after undersized mitral ring annuloplasty. Methods: The study population consisted of 362 patients, who were divided into two groups by baseline α′: group 1, α′ <39.5° (n = 196), and group 2, α′ ≥ 39.5° (n = 166). End points were recurrent MR ≥ 2+; LVRR, defined as a reduction in end-systolic volume index > 15%; and LV geometric reverse remodeling, defined as a reduction in systolic sphericity index to a normal value of .05). When we allowed for interactions between α′ and other risk factors, this effect occurred also in low-risk subgroups, and it was equivalent or generally attenuated in higher risk patients. There were no significant interactions between α′ and any of the covariates (all P values >.05). Conclusions: Anterior mitral leaflet tethering is a powerful predictor of MR recurrence and lack of LVRR after undersized mitral ring annuloplasty. Evaluation of leaflet tethering should be incorporated into clinical risk assessment and prediction models.

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