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Journal of Cardiovascular Magnetic Resonance
Published in: Journal of Cardiovascular Magnetic Resonance 1/2023

Open Access 01-12-2023 | Mitral Valve Replacement | Research

Cardiac reverse remodeling in primary mitral regurgitation: mitral valve replacement vs. mitral valve repair

Authors: Thomas P. Craven, Pei G. Chew, Laura E. Dobson, Miroslawa Gorecka, Martine Parent, Louise A. E. Brown, Christopher E. D. Saunderson, Arka Das, Amrit Chowdhary, Nicholas Jex, David M. Higgins, Erica Dall’Armellina, Eylem Levelt, Dominik Schlosshan, Peter P. Swoboda, Sven Plein, John P. Greenwood

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2023

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Abstract

Background

When feasible, guidelines recommend mitral valve repair (MVr) over mitral valve replacement (MVR) to treat primary mitral regurgitation (MR), based upon historic outcome studies and transthoracic echocardiography (TTE) reverse remodeling studies. Cardiovascular magnetic resonance (CMR) offers reference standard biventricular assessment with superior MR quantification compared to TTE. Using serial CMR in primary MR patients, we aimed to investigate cardiac reverse remodeling and residual MR post-MVr vs MVR with chordal preservation.

Methods

83 patients with ≥ moderate-severe MR on TTE were prospectively recruited. 6-min walk tests (6MWT) and CMR imaging including cine imaging, aortic/pulmonary through-plane phase contrast imaging, T1 maps and late-gadolinium-enhanced (LGE) imaging were performed at baseline and 6 months after mitral surgery or watchful waiting (control group).

Results

72 patients completed follow-up (Controls = 20, MVr = 30 and MVR = 22). Surgical groups demonstrated comparable baseline cardiac indices and co-morbidities. At 6-months, MVr and MVR groups demonstrated comparable improvements in 6MWT distances (+ 57 ± 54 m vs + 64 ± 76 m respectively, p = 1), reduced indexed left ventricular end-diastolic volumes (LVEDVi; − 29 ± 21 ml/m2 vs − 37 ± 22 ml/m2 respectively, p = 0.584) and left atrial volumes (− 23 ± 30 ml/m2 and − 39 ± 26 ml/m2 respectively, p = 0.545). At 6-months, compared with controls, right ventricular ejection fraction was poorer post-MVr (47 ± 6.1% vs 53 ± 8.0% respectively, p = 0.01) compared to post-MVR (50 ± 5.7% vs 53 ± 8.0% respectively, p = 0.698). MVR resulted in lower residual MR-regurgitant fraction (RF) than MVr (12 ± 8.0% vs 21 ± 11% respectively, p = 0.022). Baseline and follow-up indices of diffuse and focal myocardial fibrosis (Native T1 relaxation times, extra-cellular volume and quantified LGE respectively) were comparable between groups. Stepwise multiple linear regression of indexed variables in the surgical groups demonstrated baseline indexed mitral regurgitant volume as the sole multivariate predictor of left ventricular (LV) end-diastolic reverse remodelling, baseline LVEDVi as the most significant independent multivariate predictor of follow-up LVEDVi, baseline indexed LV end-systolic volume as the sole multivariate predictor of follow-up LV ejection fraction and undergoing MVR (vs MVr) as the most significant (p < 0.001) baseline multivariate predictor of lower residual MR.

Conclusion

In primary MR, MVR with chordal preservation may offer comparable cardiac reverse remodeling and functional benefits at 6-months when compared to MVr. Larger, multicenter CMR studies are required, which if the findings are confirmed could impact future surgical practice.
Appendix
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Metadata
Title
Cardiac reverse remodeling in primary mitral regurgitation: mitral valve replacement vs. mitral valve repair
Authors
Thomas P. Craven
Pei G. Chew
Laura E. Dobson
Miroslawa Gorecka
Martine Parent
Louise A. E. Brown
Christopher E. D. Saunderson
Arka Das
Amrit Chowdhary
Nicholas Jex
David M. Higgins
Erica Dall’Armellina
Eylem Levelt
Dominik Schlosshan
Peter P. Swoboda
Sven Plein
John P. Greenwood
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Journal of Cardiovascular Magnetic Resonance / Issue 1/2023
Electronic ISSN: 1532-429X
DOI
https://doi.org/10.1186/s12968-023-00946-9

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