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Predictors and Clinical Impact of Functional Mitral Stenosis Induced by Restrictive Annuloplasty for Ischemic and Functional Mitral Regurgitation

Background:There are few reports of the determinants of “functional” mitral stenosis in terms of a residual mitral valve (MV) pressure gradient >5 mmHg following restrictive mitral annuloplasty (RMA) or the effect on long-term outcome in patients with functional mitral regurgitation (MR).Methods ...

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Published in:Circulation Journal 2017/11/24, Vol.81(12), pp.1832-1838
Main Authors: Kainuma, Satoshi, Taniguchi, Kazuhiro, Toda, Koichi, Funatsu, Toshihiro, Kondoh, Haruhiko, Miyagawa, Shigeru, Yoshikawa, Yasushi, Hata, Hiroki, Saito, Shunsuke, Ueno, Takayoshi, Kuratani, Toru, Daimon, Takashi, Masai, Takafumi, Sawa, Yoshiki, Osaka Cardiovascular Surgery Research (OSCAR) Group
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Language:English
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Summary:Background:There are few reports of the determinants of “functional” mitral stenosis in terms of a residual mitral valve (MV) pressure gradient >5 mmHg following restrictive mitral annuloplasty (RMA) or the effect on long-term outcome in patients with functional mitral regurgitation (MR).Methods and Results:Serial cardiac catheterization and echocardiographic studies were performed in 55 patients with functional MR who underwent RMA using a 24/26-mm semi-rigid complete ring. The mean postoperative (1 month) catheter-measured MV gradient was 3.4±1.6 mmHg, which was independently associated with corresponding cardiac output [standardized partial regression coefficient (SPRC)=0.59] and indexed effective orifice area (SPRC=−0.25). Body surface area (BSA) had the greatest contribution to MV gradient (SPRC=0.38), followed by use of a 24-mm ring (SPRC=0.33) and hemodialysis (SPRC=0.26). Receiver-operating characteristic curve analysis demonstrated an optimal BSA cutoff value of 1.86 m2to predict post-MV stenosis (21% for
ISSN:1346-9843
1347-4820
DOI:10.1253/circj.CJ-17-0060