Cardiology and Imaging in Cardiac Surgery/Intraoperative and Early Assessment of the Results of Surgery. SESSION-1
Clinical Application of the Three-dimensional Transesophageal Echocardiography and Mitral Valve Quantification in Mitral Valve Surgery
Violeta Dzhanketova, Elena Z. Golukhova, Tatiana V. Mashina , Gufron A. Shamsiev, David V. Mrikaev
A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia
Date, time and location: 2018.05.27 08:30, Congress Hall, 2F–A
Objective: The aim of the study was to assess the significance of transesophageal 3D echocardiographic (3D-TEE) and mitral valve quantification (MVQ) parameters as prognostic markers for successful mitral valve repair.
Methods: The study included 64 patients with significant MR (degenerative, arrhythmogenic and ischemic origin) who underwent MV surgery. The mean age was 52,2 ± 13,2 years. Twenty patients without MV abnormalities were included in the control group, mean age was 58 ± 13 years. For all patients undergoing MV repair the valve geometry was assessed using 3D-TEE with (MVQ) software before and after surgery. In patients who underwent MV replacement, the valve geometry was assessed before implantation and compared with MV repair group to identify parameters affecting the choice of valve repair or replacement.
Results: 49 (77%) patients underwent MV repair and 15 (23%) patients - MV replacement. Following significant differences in valve geometry in pts with degenerative MR after successful MV repair and replacement were revealed: commissural diameter, annular height, prolapse volume, antero-lateral and postero-medial chord length. According to ROC-curve analysis the greatest significance in predicting unsuccessful MV repair was found for the following parameters: prolapse volume (p = 0.002), tenting height (p = 0.0035), chord length (anterolateral and posteromedial) (p = 0.004). According to the MVQ data following predictors of unsuccessful MV repair were revealed: prolapse volume > 3.2 ml, tenting height > 11.5 mm, antero-lateral chord length > 28.5 mm and postero- medial chord length > 28,1 mm; in these cases MV replacement is preferable.
Conclusions: RT 3D-TEE and MVQ allows to choose the optimal method of MV surgery: repair or replacement for each patient and to assess the effectiveness of operation. The most significant predictors of unsuccessful MV repair in our study were: prolapse volume, tenting height, antero-lateral chord length and postero- medial chord length.