Early and Long-term Echocardiographic Assessment Following Minimally Invasive Mitral Valve Repair
Witold Gerber1, Krzysztof Sanetra2, Agnieszka Drzewiecka-Gerber1, Justyna Jankowska- Sanetra1, Andrzej Bochenek3, Krzysztof Bialek1, Marek Cisowski4
1American Heart of Poland, Bielsko-Bia?a, Poland, 2Andrzej Frycz Modrzewski Krakow University, Krakow, Poland, 3University of Technology, Katowice, Poland, 4Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Zabrze, Poland
BACKGROUND:Reverse remodelling of cardiac chambers after valve surgery remains one of key factors determining long-term clinical outcome. The study was conducted to evaluate the significance and long-term stability of reverse remodelling following minimally invasive mitral valve repair.
METHODS: Consecutive patients who underwent mitral valve repair due to severe, primary mitral regurgitation were assessed in clinical and echocardiographic long-term follow-up. The analysed echocardiographic parameters included: EF- ejection fraction; EDV- end-diastolic volume; ESV- end systolic volume; EDD end diastolic diameter; ESD- end systolic diameter; LA Area- left atrial area, LA volume- left atrial volume; RA volume- right atrial volume. The echocardiography was performed before the surgery, in the 1st, 6th, 12th and 24th month after the surgery.
RESULTS:A group of 145 patients was included in the report. Throughout the clinical observation, one death (0.7%), two reoperations (1.4%) and no stroke or myocardial infarction were noted. The statistical difference (baseline vs 1st month vs 6 month vs 12th month vs 24th month) was visible in median EF (68% vs 57% vs 60% vs 60% vs 61%; p<0.000001), EDV (165cm3 vs 109 cm3 vs 104 cm3 vs 100 cm3 vs 109 cm3; p <0.000001), ESV (51cm3 vs 46 cm3 vs 42 cm3 vs 40 cm3 vs 42 cm3; p= 0.000781), EDD (58 mm vs 50 mm vs 50 mm vs 49 mm vs 49 mm; p<0.000001), ESD (35 mm vs 33 mm vs 32 mm vs 30 mm vs 30mm; p=0.000044), LA area (26 cm2 vs 19 cm2 vs 18 cm2 vs 18 cm2 vs 18 cm2; p<0.000001) and LA volume (96 cm3 vs 60 cm3 vs 54 cm3 vs 54 cm3 vs 49 cm3; p<0.000001). No statistical difference was shown in median RA area (15 cm2 vs 15 cm2 vs 14 cm2 vs 14 cm2 vs 13 cm2; p= 0.063158).
CONCLUSIONS:Minimally invasive mitral valve repair is an efficient method of treatment for severe, primary mitral regurgitation. Reverse remodelling of left ventricle and left atrium is visible in the first moth following surgery and remains stable in consecutive time intervals.