Valvular & structural heart disease
Prosthetic annulus size mismatch and recurrent mitral regurgitation after repair in advanced degenerative disease
Main finding · Recurrent MR (≥grade 2), death treated as a competing riskResult — go to the resultAdjusted subdistribution hazard ratio 1.95 95% CI 1.65–2.30Authors' conclusion
In patients with asDMR, a larger LVESD-to-POA ratio identifies those at elevated risk of recurrent regurgitation and progressive LV remodelling after repair. Preoperative echocardiographic assessment of LV-annulus proportionality may help optimise prosthesis sizing and improve long-term durability of MV repair. Prospective multicentre validation is warranted.
Study context
- Population
- Patients with advanced degenerative mitral regurgitation (MR) (asDMR, stages C2-D) and left ventricular (LV) enlargement who underwent mitral valve (MV) repair with the Medtronic CG Future or Edwards Physio II annuloplasty prosthesis between 2005 and 2019patients with asDMR who underwent MV repair
- Participants
- 445 patients
- Exposure
- mismatch vs non-mismatch
- Outcome
- Recurrent MR (≥grade 2), death treated as a competing risk
- Follow-up
- Median 6.0 years
Methodological detailspropensity-score matching (1:1), death treated as a competing risk
- Propensity-score matching (1:1)
- Death treated as a competing risk
Main finding
As reported in the abstract
Adjusted subdistribution hazard ratio
1.95
95% CI 1.65–2.30
P < 0.001
- Patients who developed recurrent MR
- 15.5%
Observational data: associations, not effects.
Further findings
5-year cumulative MR recurrence
- 5-year cumulative MR recurrence: p=0.02
- 5-year cumulative MR recurrence: threshold of 12.25 mm/cm²
Death · median follow-up of 6.0 years
- Patients who died
- 10.6%
Postoperative LV re-enlargement
- Faster postoperative LV re-enlargement in the mismatch cohort compared with the non-mismatch group
Mortality
- Mortality did not differ between groups
Propensity-matched analysis
- Findings consistent after propensity matching
Original publication
Summarised from the published abstract; every number is checked against it