Impact of Preoperative Left Ventricular Dysfunction on Residual and Recurrent Mitral Regurgitation After Degenerative Mitral Valve Repair.

Abstract

Data are limited for investigating causes for progression of degenerative mitral regurgitation (MR) after mitral valve repair. Between June 2, 2004, and May 21, 2018, 1155 patients underwent elective mitral valve repair for degenerative MR at our institution. Speckle-tracking analysis of preoperative echocardiograms was used to calculate left ventricular (LV) strain in 16 LV wall segments, assessing the frequency and location of subclinical segmental LV dysfunction in patients with postoperative early residual (>1+ or late recurrent ≥2+ MR). Seventy-three patients with early >1+ MR were propensity score-matched to 157 without residual MR. Despite a normal preoperative LV ejection fraction of 0.63 in both groups, LV global longitudinal strain was impaired in patients with early MR, and LV segmental strain was abnormal in nearly all LV segments, except for the inferior basal wall. Among 196 propensity score-matched patients with long-term follow-up, late ≥2+ MR developed in 39. Compared with157 patients without late MR, those with late recurrence had similar LV ejection fraction (0.53 and 0.58, respectively; P = .26), but abnormal preoperative LV segmental strain, particularly in regions supporting the papillary muscles. Logistic regression analysis demonstrated that among these regions, segment 1 (anterior basal wall) was independently associated with late MR recurrence. Preoperative LV segmental strain analysis demonstrated abnormalities in the anterolateral and posteromedial papillary muscle region in patients who developed early and late recurrent MR. This observation may be helpful for the timing of surgery and for intraoperative decision-making during mitral valve repair for degenerative MR.