Elevated gradient after mitral valve repair: The effect of surgical technique and relevance of postoperative atrial fibrillation

The Journal of Thoracic and Cardiovascular Surgery

Wei Shi¹  Wenrui Ma²  Weihua Wu³ 

[1] Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China;Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China;Department of Echocardiography, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China

关键词: mitral valve repair;    degenerative mitral regurgitation;    atrial fibrillation;   

DOI  :  10.1016/j.jtcvs.2018.07.107

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectivesWe sought to investigate the effect of surgical technique in mitral valve repair on postoperative transmitral gradient (PTMG) and the relationship between PTMG and postoperative atrial fibrillation (AF).MethodsIn this retrospective study, 390 patients who underwent mitral valve repair for degenerative mitral regurgitation without AF were included. PTMG was measured using transthoracic echocardiography before patient discharge. At follow-up, occurrences of AF within 6 months of surgery (early AF) and 6 months after surgery (late AF), as well as clinical and echocardiographic data were documented and investigated.ResultsThe in-hospital mortality was 0, and the mean gradient was 3.1 ± 1.2 mm Hg before patient discharge. The risks for higher PTMG included cleft closure, edge-to-edge technique, full ring annuloplasty, and smaller indexed prosthetic size (P P = .004). The minimum P value approach identified a mean gradient of ≥4.5 mm Hg as the best threshold for predicting late AF (χ2 = 40.704; P ConclusionsPatients who undergo mitral valve repair for degenerative mitral insufficiency might benefit from modification of the existing leaflet repair and annuloplasty techniques to achieve a lower PTMG level, which is associated with a decreased incidence of late AF during midterm follow-up.

【 授权许可】

Unknown