Predicting recurrent mitral regurgitation after mitral valve repair for severe ischemic mitral regurgitation

Irving L. Kron, Judy Hung, Jessica R. Overbey, Denis Bouchard, Annetine C. Gelijns, Alan J. Moskowitz, Pierre Voisine, Patrick T. O'Gara, Michael Argenziano, Robert E. Michler, Marc Gillinov, John D. Puskas, James S. Gammie, Michael J. Mack, Peter K. Smith, Chittoor Sai-Sudhakar, Timothy J. Gardner, Gorav Ailawadi, Xin Zeng, Karen O'Sullivan & 6 others Michael K. Parides, Roger Swayze, Vinod Thourani, Eric A. Rose, Louis P. Perrault, Michael A. Acker

Research output: Contribution to journalArticle

92 Citations (Scopus)

Abstract

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 = 126) or replacement (n = 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 model-based 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 Of the 116 patients, 6 received a replacement before leaving the operating room; all other patients had mild or less mitral regurgitation on intraoperative echocardiogram 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 coronary artery bypass grafting, percutaneous coronary intervention, or ventricular 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.

Original languageEnglish (US)
Pages (from-to)752-761.e1
JournalJournal of Thoracic and Cardiovascular Surgery
Volume149
Issue number3
DOIs
StatePublished - Mar 1 2015

Fingerprint

Mitral Valve Insufficiency
Mitral Valve
Recurrence
ROC Curve
Percutaneous Coronary Intervention
Operating Rooms
Coronary Artery Bypass
Stroke Volume
Aneurysm
Cardiac Arrhythmias
Body Mass Index
Logistic Models
Sensitivity and Specificity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Kron, I. L., Hung, J., Overbey, J. R., Bouchard, D., Gelijns, A. C., Moskowitz, A. J., ... Acker, M. A. (2015). Predicting recurrent mitral regurgitation after mitral valve repair for severe ischemic mitral regurgitation. Journal of Thoracic and Cardiovascular Surgery, 149(3), 752-761.e1. https://doi.org/10.1016/j.jtcvs.2014.10.120

Predicting recurrent mitral regurgitation after mitral valve repair for severe ischemic mitral regurgitation. / Kron, Irving L.; Hung, Judy; Overbey, Jessica R.; Bouchard, Denis; Gelijns, Annetine C.; Moskowitz, Alan J.; Voisine, Pierre; O'Gara, Patrick T.; Argenziano, Michael; Michler, Robert E.; Gillinov, Marc; Puskas, John D.; Gammie, James S.; Mack, Michael J.; Smith, Peter K.; Sai-Sudhakar, Chittoor; Gardner, Timothy J.; Ailawadi, Gorav; Zeng, Xin; O'Sullivan, Karen; Parides, Michael K.; Swayze, Roger; Thourani, Vinod; Rose, Eric A.; Perrault, Louis P.; Acker, Michael A.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 149, No. 3, 01.03.2015, p. 752-761.e1.

Research output: Contribution to journalArticle

Kron, IL, Hung, J, Overbey, JR, Bouchard, D, Gelijns, AC, Moskowitz, AJ, Voisine, P, O'Gara, PT, Argenziano, M, Michler, RE, Gillinov, M, Puskas, JD, Gammie, JS, Mack, MJ, Smith, PK, Sai-Sudhakar, C, Gardner, TJ, Ailawadi, G, Zeng, X, O'Sullivan, K, Parides, MK, Swayze, R, Thourani, V, Rose, EA, Perrault, LP & Acker, MA 2015, 'Predicting recurrent mitral regurgitation after mitral valve repair for severe ischemic mitral regurgitation', Journal of Thoracic and Cardiovascular Surgery, vol. 149, no. 3, pp. 752-761.e1. https://doi.org/10.1016/j.jtcvs.2014.10.120
Kron, Irving L. ; Hung, Judy ; Overbey, Jessica R. ; Bouchard, Denis ; Gelijns, Annetine C. ; Moskowitz, Alan J. ; Voisine, Pierre ; O'Gara, Patrick T. ; Argenziano, Michael ; Michler, Robert E. ; Gillinov, Marc ; Puskas, John D. ; Gammie, James S. ; Mack, Michael J. ; Smith, Peter K. ; Sai-Sudhakar, Chittoor ; Gardner, Timothy J. ; Ailawadi, Gorav ; Zeng, Xin ; O'Sullivan, Karen ; Parides, Michael K. ; Swayze, Roger ; Thourani, Vinod ; Rose, Eric A. ; Perrault, Louis P. ; Acker, Michael A. / Predicting recurrent mitral regurgitation after mitral valve repair for severe ischemic mitral regurgitation. In: Journal of Thoracic and Cardiovascular Surgery. 2015 ; Vol. 149, No. 3. pp. 752-761.e1.
@article{78b45c64562a484988182d9a33a59f5e,
title = "Predicting recurrent mitral regurgitation after mitral valve repair for severe ischemic mitral regurgitation",
abstract = "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 = 126) or replacement (n = 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 model-based 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 Of the 116 patients, 6 received a replacement before leaving the operating room; all other patients had mild or less mitral regurgitation on intraoperative echocardiogram 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 coronary artery bypass grafting, percutaneous coronary intervention, or ventricular 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.",
author = "Kron, {Irving L.} and Judy Hung and Overbey, {Jessica R.} and Denis Bouchard and Gelijns, {Annetine C.} and Moskowitz, {Alan J.} and Pierre Voisine and O'Gara, {Patrick T.} and Michael Argenziano and Michler, {Robert E.} and Marc Gillinov and Puskas, {John D.} and Gammie, {James S.} and Mack, {Michael J.} and Smith, {Peter K.} and Chittoor Sai-Sudhakar and Gardner, {Timothy J.} and Gorav Ailawadi and Xin Zeng and Karen O'Sullivan and Parides, {Michael K.} and Roger Swayze and Vinod Thourani and Rose, {Eric A.} and Perrault, {Louis P.} and Acker, {Michael A.}",
year = "2015",
month = "3",
day = "1",
doi = "10.1016/j.jtcvs.2014.10.120",
language = "English (US)",
volume = "149",
pages = "752--761.e1",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Predicting recurrent mitral regurgitation after mitral valve repair for severe ischemic mitral regurgitation

AU - Kron, Irving L.

AU - Hung, Judy

AU - Overbey, Jessica R.

AU - Bouchard, Denis

AU - Gelijns, Annetine C.

AU - Moskowitz, Alan J.

AU - Voisine, Pierre

AU - O'Gara, Patrick T.

AU - Argenziano, Michael

AU - Michler, Robert E.

AU - Gillinov, Marc

AU - Puskas, John D.

AU - Gammie, James S.

AU - Mack, Michael J.

AU - Smith, Peter K.

AU - Sai-Sudhakar, Chittoor

AU - Gardner, Timothy J.

AU - Ailawadi, Gorav

AU - Zeng, Xin

AU - O'Sullivan, Karen

AU - Parides, Michael K.

AU - Swayze, Roger

AU - Thourani, Vinod

AU - Rose, Eric A.

AU - Perrault, Louis P.

AU - Acker, Michael A.

PY - 2015/3/1

Y1 - 2015/3/1

N2 - 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 = 126) or replacement (n = 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 model-based 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 Of the 116 patients, 6 received a replacement before leaving the operating room; all other patients had mild or less mitral regurgitation on intraoperative echocardiogram 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 coronary artery bypass grafting, percutaneous coronary intervention, or ventricular 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.

AB - 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 = 126) or replacement (n = 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 model-based 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 Of the 116 patients, 6 received a replacement before leaving the operating room; all other patients had mild or less mitral regurgitation on intraoperative echocardiogram 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 coronary artery bypass grafting, percutaneous coronary intervention, or ventricular 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.

UR - http://www.scopus.com/inward/record.url?scp=84926196353&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84926196353&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2014.10.120

DO - 10.1016/j.jtcvs.2014.10.120

M3 - Article

VL - 149

SP - 752-761.e1

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 3

ER -