Introduction
Methods
Patient population
Control group
Study protocol
Echocardiography
Exercise echocardiography
Statistical analysis
Results
Study participants
n = 56 | |
---|---|
Preoperative characteristics of the study group | |
Age at surgery (years) | 60.0 ± 9.7 |
Female gender | 17 (30%) |
NYHA class III–IV | 24 (43%) |
LVEF < 50% | 3 (5.4%) |
PASP > 60 mmHg | 17 (30%) |
Logistic EuroSCORE | 3.0 ± 1.6 |
Operative data | |
Ring type | |
Cosgrove-Edwards® mitral annuloplasty system | 3 (5.4%) |
Duran Ancore® band | 46 (82%) |
Physio II® semirigid ring | 7 (12.5%) |
Affected scallop | |
P1 | 3 (5.4%) |
P2 | 55 (98%) |
P3 | 8 (14.3%) |
Prolapse of 2 or 3 scallops | 9 (16%) |
Type of repair | |
Leaflet resection | 32 (57%) |
Artificial chordae | 24 (43%) |
Ring size (mm) | 31.4 ± 2.7 |
ECC time (min) | 110 ± 29 |
Cross-clamp time (min) | 84 ± 23 |
Study group (n = 56) | Control group (n = 13) | p value | |
---|---|---|---|
Clinical assessment | |||
Age at assessment (years) | 65.5 ± 10.0 | 64.0 ± 9.7 | 0.63 |
Female gender | 17 (30%) | 4 (30%) | 1.0 |
NYHA I/II/III/IV | 46/9/1/0 | 12/1/0/0 | |
Short form assessment (Duke Activity Status Index) | 52 ± 10 | 55 ± 4 | 0.26 |
BSA according to DuBois formula | 1.95 ± 0.21 | 2.0 ± 0.18 | 0.47 |
Current medications | |||
Beta blocker | 35 (63%) | 3 (23%) | 0.01 |
Calcium channel blocker | 7 (13%) | 0 | 0.33 |
ACE inhibitor or ARB | 21 (38%) | 1 (8%) | 0.03 |
Resting heart rate and blood pressure | |||
Atrial fibrillation | 0 | 0 | |
Resting heart rate (BPM) | 75 ± 11 | 74 ± 11 | 0.74 |
Resting systolic BP (mmHg) | 137 ± 15 | 138 ± 13 | 0.9 |
Measurements during exercise | |||
Maximum heart rate (BPM) | 128 ± 20 | 129 ± 18 | 0.87 |
Maximum systolic BP (mmHg) | 174 ± 31 | 181 ± 45 | 0.48 |
Duration (min) | 9.1 ± 3.5 | 11.1 ± 4.1 | 0.33 |
Maximum effort (W) | 133 ± 41 | 154 ± 47 | 0.12 |
Exercise capacity
Right ventricular function
Measure |
n
| Study group (n = 56) |
n
| Control group (n = 13) | p value |
---|---|---|---|---|---|
Baseline measures | |||||
Any mitral insufficiency | 56 | 10 (18%) | 13 | 0 | 0.19 |
Mild | 9 (16%) | 0 | |||
Moderate | 0 | 0 | |||
Severe | 1 (2%) | 0 | |||
SAM | 56 | 5 (9%) | 13 | 0 | 1.0 |
Indexed LA volume (mL/m2) | 45 | 35.7 ± 11.2 | 0 | ||
LVEF (%) | 51a | 62.0 ± 6.0 | 6a | 59.7 ± 3.1 | 0.29 |
LVIDd (mm) | 53 | 45.5 ± 5.4 | 11 | 43.7 ± 6.5 | 0.31 |
LVPWd (mm) | 53 | 12.1 ± 1.8 | 11 | 11.3 ± 1.1 | 0.17 |
Mean mitral valve gradient (mmHg) | 52 | 3.0 ± 1.1 | 2 | 0.7 ± 0.1 | 0.005 |
E/e′ | 48 | 15.9 ± 4.3 | 11 | 7.1 ± 2.9 | < 0.001 |
Peak aortic gradient (mmHg) | 53 | 6.1 ± 2.9 | 12 | 9.4 ± 10.2 | 0.042 |
TRmaxPG (mmHg) | 42 | 23.8 ± 5.5 | 3 | 22.1 ± 4.0 | 0.54 |
Interventricular septal movement (mm) | 48 | 7.0 ± 1.3 | 10 | 8.9 ± 2.0 | < 0.001 |
TAPSE (mm) | 52 | 16.7 ± 3.3 | 12 | 24.4 ± 4.3 | < 0.001 |
S′ (cm/s) | 55 | 10.6 ± 2.6 | 12 | 14.3 ± 2.5 | < 0.001 |
Peak exercise measures | |||||
Any mitral insufficiency (grade 1–4) | 56 | 11 (20%) | 13 | 0 | 0.11 |
Mild | 10 (18%) | 0 | |||
Moderate | 0 | 0 | |||
Severe | 1 (2%) | 0 | |||
SAM | 56 | 5 (9%) | 13 | 0 | 1.0 |
Mean mitral gradient (mmHg) | 51 | 10.1 ± 7.2 | 0 | ||
Peak aortic gradient (mmHg) | 46 | 11.1 ± 3.8 | 12 | 17.2 ± 13.9 | 0.01 |
TRmaxPG (mmHg) | 29 | 38.8 ± 11.9 | 4 | 23.9 ± 9.4 | 0.03 |
TAPSE (mm) | 40 | 19.8 ± 4.2 | 12 | 34.6 ± 3.8 | < 0.001 |
S′ (cm/s) | 33 | 14.5 ± 6.7 | 13 | 20.7 ± 5.1 | 0.005 |