Recurrence of functional mitral regurgitation in patients with dilated cardiomyopathy undergoing mitral valve repair: how to predict it

Department of Cardiology and Cardiac Surgery, University ‘G D'Annunzio’, S Camillo de Lellis Hospital, via Forlanini 50, 66100 Chieti, Italy *Corresponding author. Tel.: +39-0871358628; fax: +39-0871357552. E-mail address : gabriele.digiammarco1{at}tin.it (G. Di Giammarco). This study was aimed at identifying predictive variables for recurrence of mitral regurgitation (MR) in patients with dilated cardiomyopathy (DCM) undergoing mitral valve (MV) repair. From January 1997 to December 2005, 142 patients with DCM, 105 (73.9%) ischemic and 37 (26.1%) non-ischemic, underwent MV repair. Mean age was 66±10 years and mean MR grade was 3.2±0.7 (scale 1+ to 4+). Ninety-seven (71% ischemic, 29% non-ischemic), out of 98 still alive at follow-up, were included in this retrospective analysis. In all cases MV posterior annuloplasty was performed; all patients were followed-up by echocardiography (mean time interval of 44±28 months) to evaluate MR recurrence ( 2+/4+). Thirty-day mortality was 9.2% (13 patients). Mean MR grade at follow-up was 0.9±0.9. Four-year freedom from MR recurrence was 65.5%±8.3. Cox analysis showed left ventricular end-diastolic volume index (LVEDVi, OR=1.03, P =0.016, AUC=0.72), left ventricular end-systolic volume index (LVESVi, OR=1.03, P =0.033, AUC=0.71), left ventricular ejection fraction (LVEF, OR=0.82, P =0.001, AUC=0.72), mitral valve coaptation depth (MVCD, OR=1.6, P =0.017, AUC=0.72) to be predictive variables for MR recurrence. Preoperative left ventricular dilatation and function along with degree of papillary muscle displacement can be helpful in identifying patients with higher probability to undergo a durable MV repair. Key Words: Functional mitral incompetence; Dilated cardiomyopathy; Valve surgery; Mitral annuloplasty