Predictingrecurrentmitralregurgitationaftermitralvalverepairfor severe ischemic mitral regurgitation

Objectives:The Cardiothoracic Surgical Trials Network recently reported no difference in the primary end point of left ventricular end-systolic volume index at 1 year postsurgery in patients randomized to repair (n ¼ 126) or replacement (n ¼ 125) for severe ischemic mitral regurgitation. However, patients undergoing repair experienced significantly more recurrent mitral regurgitation than patients undergoing replacement (32.6% vs 2.3%). We examined whether baseline echocardiographic and clinical characteristics could identify those who will develop moderate/severe recurrent mitral regurgitation or die. Methods: Our analysis includes 116 patients who were randomized to and received mitral valve repair. Logistic regression was used to estimate a modelbased probability of recurrence or death from baseline factors. Receiver operating characteristic curves were constructed from these estimated probabilities to determine classification cut-points maximizing accuracy of prediction based on sensitivity and specificity. Results: Ofthe116patients,6receivedareplacementbeforeleavingtheoperating room;allotherpatientshadmildorlessmitralregurgitationonintraoperativeechocardiogram after repair. During the 2-year follow-up period, 76 patients developed moderate/severe mitral regurgitation or died (53 mitral regurgitation recurrences, 13 mitral regurgitation recurrences and death, and 10 deaths). The mechanism for recurrent mitral regurgitation was largely mitral valve leaflet tethering. Our model (including age, body mass index, sex, race, effective regurgitant orifice area, basal aneurysm/dyskinesis, New York Heart Association class, history of coronaryarterybypassgrafting,percutaneouscoronaryintervention,orventricular arrhythmias) yielded an area under the receiver operating characteristic curve of 0.82. Conclusions: The model demonstrated good discrimination in identifying patients who will survive 2 years without recurrent mitral regurgitation after mitral valve repair. Although our results require validation, they offer a clinically relevant risk score for selection of surgical candidates for this procedure. (J Thorac Cardiovasc Surg 2015;149:752-61) Basal aneurysm/dyskinesis is an important predictor of recurrent MR after ischemic MR repair.