Clinical Outcomes of a Customized Mitral Valve Plasty for Functional Mitral Regurgitation with  a Low Ejection Fraction and Implications for  Preoperative Right Ventricular Function

Koji Furukawa; Mitsuhiro Yano; Hirohito Ishii; Shuhei Sakaguchi; Kousuke Mori; Masanori Nishimura; Kunihide Nakamura

doi:10.5761/atcs.oa.20-00035

Original Articles

Clinical Outcomes of a Customized Mitral Valve Plasty for Functional Mitral Regurgitation with a Low Ejection Fraction and Implications for Preoperative Right Ventricular Function

Koji Furukawa, Mitsuhiro Yano, Hirohito Ishii, Shuhei Sakaguchi, Kousuke Mori, Masanori Nishimura, Kunihide Nakamura

Author information

Koji Furukawa
Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Miyazaki, Japan
Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
Mitsuhiro Yano
Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Miyazaki, Japan
Hirohito Ishii
Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
Shuhei Sakaguchi
Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
Kousuke Mori
Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
Masanori Nishimura
Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Miyazaki, Japan
Kunihide Nakamura
Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan

Keywords: functional mitral regurgitation, mitral valve plasty, subvalvular procedure, right ventricular function, RVFAC

JOURNAL OPEN ACCESS

2021 Volume 27 Issue 1 Pages 32-40

DOI https://doi.org/10.5761/atcs.oa.20-00035

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Abstract

Purpose: To evaluate clinical outcomes of customized mitral valve plasty (MVP) for the treatment of functional mitral regurgitation (FMR) with a low ejection fraction (EF) and to determine which preoperative factors affected the clinical outcome.

Methods and Results: MVP was adjusted according to the degree of left ventricle (LV) remodeling. We performed mitral annuloplasty (MAP) alone in 14 patients and added subvalvular procedures (SVPs) in 22 patients at a high risk of recurrent MR. During follow-up, reverse LV remodeling was obtained and the 3-year and 5-year non-recurrence rates of MR grade ≥2 were 94% and 89%, respectively. Two patients died during their hospital stay, and four more patients died of cardiac causes during follow-up. The 3-year and 5-year rates of freedom from cardiac-related mortality were 86% and 81%, respectively; no significant difference was observed between the two treatment groups. Right ventricular fractional area change (RVFAC) was a significant predictor of cardiac mortality. Patients with an RVFAC of <26% had significantly poorer cardiac-related mortality (71% at 3 years) than those with an RVFAC of ≥26% (95% at 3 years).

Conclusion: Customized MVP provided durable mitral competence and reverse LV remodeling. Preoperative RV function was associated with cardiac-related mortality.

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