© 2014 Wiley Periodicals, Inc.
27
ORIGINAL ARTICLE _____________________________________________________________
Surgical Treatment of Functional Mitral Regurgitation Involving the Subvalvular Apparatus Yasuyuki Kato, M.D.,* Ko Bando, M.D.,* Toshihiro Fukui, M.D.,* Keitaro Mahara, M.D.,y and Shuichiro Takanashi, M.D.* *Department of Cardiovascular Surgery, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo 183-0003, Japan; and yDepartment of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo 183-0003, Japan ABSTRACT Background and aim of the study: We retrospectively studied outcomes after mitral annuloplasty (MAP) combined with subvalvular procedures for patients with functional mitral regurgitation and ischemic dilated cardiomyopathy. We focused on changes in mitral regurgitation (MR) grade, mitral valve tethering, and left ventricular (LV) volume before and after surgery. Methods: Thirty-one patients underwent MAP combined with subvalvular procedures including papillary muscle (PM) approximation, PM relocation, and chordal cutting. Fifteen patients underwent left ventriculoplasty. Twenty patients underwent PM approximation, and 11 patients underwent PM relocation. Two patients underwent chordal cutting in addition to PM approximation or relocation. In 25 patients, echocardiographic measurements of MR grade, mitral valve tethering, and LV volume were compared among three time points: before, immediately after, and one year after surgery. Results: There were no in-hospital deaths. LV volume as well as both tenting height and area were significantly reduced immediately after and at one year after surgery. Five patients developed recurrent MR at one year after surgery. In comparison with the other 20 patients, the preoperative MR grade was significantly higher (p = 0.018). The postoperative reduction of LV volume was significant in patients without recurrent MR. Conclusions: Both tenting height and area could be significantly reduced and maintained after MAP combined with subvalvular procedures. The preoperative MR grade and the presence of a large postoperative LV volume were more likely to result in recurrent MR. However, among patients with recurrent MR, the MR grade does not increase during mid-term follow-up. doi: 10.1111/jocs.12459 (J Card
Surg 2015;30:27–34)
Functional mitral regurgitation (FMR) is a complex and formidable problem that influences early and late outcomes following cardiac surgery. In patients with ischemic cardiomyopathy, even a mild degree of FMR adversely affects survival.1,2 Restrictive mitral annuloplasty (MAP) combined with coronary artery bypass grafting (CABG) is the most frequent surgical treatment for FMR. However, higher rates of recurrent mitral regurgitation (MR) have been reported in patients treated with restrictive MAP alone. FMR is not a valvular disease, but rather a ventricular problem Conflict of interest: The authors acknowledge no conflict of interest in the submission. Address for correspondence: Yasuyuki Kato, Department of Cardiovascular Surgery, Sakakibara Heart Institute, 3-16-1, Asahi-cho, Fuchu, Tokyo 183-0003, Japan. Fax: þ81-42-314-3199; e-mail: [email protected]
resulting from leaflet tethering caused by papillary muscle (PM) displacement and annular dilatation after myocardial infarction.3–8 Restrictive MAP displaces the posterior annulus anteriorly, leading to significant posterior leaflet tethering. This phenomenon is considered to be the main cause of persistent or recurrent MR after restrictive MAP. Recently, several surgical procedures of the mitral valve leaflets, chordae tendineae, PMs, and left ventricle (LV) to correct leaflet tethering have been reported.9–15 Among those procedures, we performed chordal cutting, PM approximation, and PM relocation in selected patients. This study retrospectively reviewed the outcomes after surgery using these techniques with or without left ventriculoplasty for the treatment of FMR with ischemic cardiomyopathy. Using echocardiography, we also investigated early and late changes in MR grade, mitral valve tethering, and LV volume after surgery.
28
KATO, ET AL. SURGERY FOR FMR INVOLVING SUBVALVULAR APPARATUS
MATERIALS AND METHODS Patient population Between December 2004 and December 2012, 58 patients with ischemic cardiomyopathy with an ejection fraction (EF) of 0.999 >0.999 0.0887 0.101 0.226 >0.999 0.611 >0.999 0.179
BSA, body surface area; NYHA, New York Heart Association; DM, diabetes mellitus; DL, dyslipidemia; PVD, peripheral vascular disease; CVD, cerebral vascular disease; HD, hemodialysis; COPD, chronic obstructive pulmonary disease; Af, atrial fibrillation; PCI, percutaneous coronary intervention; HF, heart failure.
J CARD SURG 2015;30:27–34
KATO, ET AL. SURGERY FOR FMR INVOLVING SUBVALVULAR APPARATUS
29
TABLE 2 Operative Data All (n = 31) Ring Physio Saddle Physio II Ring size 24 26 28 30 32 Subvalvular procedure PM approximation þSuspension þChordal cutting PM relocation Posterior PM only Both PMs CABG (No. of anastomosis) Left ventriculoplasty SAVE Overlapping Linear closure Other procedures TV surgery Others Cardiac arrest time (min) CPB time (min) Operation time (min)
M Group (n = 16)
LV Group (n = 15)
P Value
19 1 11
9 0 7
10 1 4
0.398
1 8 9 7 6
0 5 4 3 4
1 3 5 4 2
0.664
20 3 2 11 3 8 3.4 1.6
8 2 1 8 3 5 3.5 1.3
6 6 3 6 4 120 51 195 54 380 85
12 1 1 3 0 3 3.1 1.8
0.135
0.516
6 6 3 4 2 122 48 182 59 376 97
2 2 119 57 207 45 386 75
0.654 >0.999 0.866 0.186 0.746
PM, papillary muscle; CABG, coronary artery bypass grafting; No., number; SAVE, septal anterior ventricular exclusion; TV, tricuspid valve, CPB, cardiopulmonary bypass.
PM approximation was performed in eight patients in the M group and 12 patients in the LV group, and PM relocation was performed in eight patients in the M group (both PMs in five patients and posterior PM only in three patients) and three patients in the LV group (both PMs in all patients). Chordal cutting was also performed for the medial aspect of the posterior leaflet in one patient in the M group, and for the middle of the posterior leaflet in one patient in the LV group. In three patients (two in the M group and one in the LV group), the approximated PMs were suspended in the central portion of the anterior mitral annulus to fix the distance between the approximated PM heads and the mitral annulus, using a pair of 3-0 polypropylene sutures that were attached proximal to the mitral annulus for approximating the PMs.
patients. One patient who underwent mitral valve replacement at one month after the initial operation was excluded from late follow-up study. LV end-diastolic volume, end-systolic volume, and EF were determined using the modified biplane Simpson’s method. The grade of MR was assessed according to the size and distance of the regurgitant jet. MR grades were as none (0), mild (1), mild to moderate or moderate (2), moderate to severe (3) or severe (4). All MR grade was assessed under the condition in which heart failure was medically managed. The tenting height (defined as the distance between the annulus and the coaptation point of the mitral leaflets), and the tenting area (defined as the area outlined by the annulus and leaflets) were measured in mid-systole in the parasternal long-axis view. Follow-up
Echocardiographic examinations Two-dimensional and Doppler echocardiography was performed in all patients using an HP Sonos system (Hewlett-Packard Co., Andover, MA, USA) before and one week after surgery. Quantitative analyses were conducted by experienced echocardiographers and reviewed by two cardiologists. Follow-up echocardiography was performed at one year after surgery in 25 patients (11 patients in the M group and 14 patients in the LV group), and changes in MR grade, mitral valve tethering, and LV volume were evaluated in these 25
The medical records were reviewed to obtain mortality and morbidity data. Postoperative complications included low cardiac output (a newly placed intraaortic balloon pump, or use of dopamine or dobutamine >5 mg/kg/min), ventricular tachycardia or fibrillation, bleeding requiring re-exploration, and respiratory failure (intubation time >48 hours). Follow-up information was collected by direct patient evaluations and telephone interviews. Unsuccessful attempts to trace patients were followed by contact with a family member or the referring physician.
30
KATO, ET AL. SURGERY FOR FMR INVOLVING SUBVALVULAR APPARATUS
J CARD SURG 2015;30:27–34
Statistical analysis All data were analyzed using StatView software version 5.0 (SAS Institute, Inc., Cary, NC, USA). Continuous variables are presented as mean standard deviation, and categorical variables are presented as absolute numbers and percentages. Data were checked for normality before statistical analysis. Normally distributed continuous variables were compared using the unpaired or paired t-test, and non-normally distributed variables were compared using the Mann–Whitney U-test or Wilcoxon signed-rank test. Categorical variables were analyzed using the x2 test or Fisher’s exact test. Changes in echocardiographic parameters over time were analyzed by repeated-measures analysis of variance, followed by the Tukey–Kramer test or Friedman’s test, as appropriate. Patient survival, freedom from cardiac-related death, and freedom from CHF requiring hospitalization were determined by the Kaplan–Meier method. Survival rates were compared between groups using the log-rank test. p < 0.05 was considered statistically significant. RESULTS Operative mortality and morbidity Early postoperative outcomes are shown in Table 3. There were no in-hospital deaths. One patient who underwent MAP with PM approximation and left ventriculoplasty required mitral valve replacement for recurrence of MR because of chordal rupture at one month after the initial operation. Low output syndrome (newly placed intraaortic balloon pump or the use of dopamine or dobutamine at doses over 5 g/kg/min) occurred in five patients. Temporary ventricular tachycardia or fibrillation occurred in two patients, and one patient required re-exploration for bleeding. Two patients required prolonged ventilation. Patient survival, freedom from cardiac death, and freedom from heart failure One patient was lost to follow-up, resulting in a follow-up rate of 96.8% (30 of 31 patients) with a mean follow-up time of 2.8 1.8 years (range 0.1 to 7.0 years). There were five late deaths in the M group and one in the LV group. One of the patients in the M group
Figure 1. Overall survival.
died of CHF, and the other four deaths were not cardiacrelated. CHF requiring hospitalization occurred in two patients in the M group and two in the LV group; none of these four patients had more than grade 2 postoperative MR. The overall three-year survival rate was 77% in the M-group and 86% in the LV group (p ¼ 0.256, Fig. 1), respectively. There were no significant difference about the three-year rate of freedom from cardiac-related death (p > 0.999) or the three-year rate of freedom from CHF requiring hospitalization (p ¼ 0.668) between patients in the M group and the LV group. Echocardiographic evaluations Immediately after surgery, mild MR was observed in three patients and moderate MR was observed in one patient. In three of these four patients, echocardiography at one year after surgery did not show a change in MR grade, and in the other patient (who had mild postoperative MR) echocardiographic data were not available at one year. Follow-up echocardiography was performed at one year after surgery in 25 patients (11 in the M group and 14 in the LV group). The echocardiographic data obtained before surgery, immediately (one week) after surgery, and at one year after surgery are shown in Table 4. MR grade was significantly reduced in both groups immediately after surgery and remained similar at one year after surgery. Grade 2 MR was observed in two patients at one year after surgery (recurrence rate of grade 2 or greater MR: 8%).
TABLE 3 Early Results
Operative results Hospital death Complications Recurrence of MR (torn chordae) Low output syndrome Bleeding Respiratory failure Vt or Vf Atrial fibrillation
All (n = 31)
M Group (n = 16)
LV Group (n = 15)
P Value
0
0
0
N/A
1 5 1 2 2 10
1 2 0 2 1 6
0 3 1 0 1 4
0.484 0.654 0.484 0.484 >0.999 0.704
MR, mitral regurgitation; Vt, ventricular tachycardia; Vf, ventricular fibrillation.
J CARD SURG 2015;30:27–34
KATO, ET AL. SURGERY FOR FMR INVOLVING SUBVALVULAR APPARATUS
31
TABLE 4 Echocardiographic Data of Preoperative, Early Postoperative, and One Year After Surgery in Each Group Variables LVEDD (mm) LVESD (mm) EF (%) LVEDV (mL) LVESV (mL) LVEDVI (mL/m2) LVESVI (mL/m2) Tenting height (mm) Tenting area (cm2) Tricuspid regurgitant pressure gradient (mmHg) MR grade
Groups
Pre
Post
One year
P Value
M LV M LV M LV M LV M LV M LV M LV M LV M LV M LV M LV
62.4 7.1 66.4 7.6 53.5 7.4 57.4 10.6 28.0 5.9 23.4 7.4 203 59 255 67 148 49 197 60 128 29 158 51 93 24 122 44 9.5 2.5 10.0 2.2 1.3 0.5 1.5 0.5 33 9 37 15 2.0 0.9 1.8 0.7
58.7 8.8 60.8 9.0 49.8 10.6 50.9 10.5 29.6 6.1 29.0 8.2 170 64 159 48 122 55 115 46 106 33 97 30 76 29 70 29 6.5 1.1 6.6 2.0 0.6 0.1 0.6 0.2 26 6 31 10 0.3 0.6 0.1 0.3
56.8 8.8 60.2 9.5 47.6 9.8 49.1 12.1 34.2 9.8 30.5 8.7 171 68 167 48 117 57 119 45 107 36 102 31 72 30 72 28 6.5 1.0 5.2 1.9 0.6 0.2 0.5 0.2 29 14 38 18 0.5 0.8 0.3 0.5
0.019#
27
ORIGINAL ARTICLE _____________________________________________________________
Surgical Treatment of Functional Mitral Regurgitation Involving the Subvalvular Apparatus Yasuyuki Kato, M.D.,* Ko Bando, M.D.,* Toshihiro Fukui, M.D.,* Keitaro Mahara, M.D.,y and Shuichiro Takanashi, M.D.* *Department of Cardiovascular Surgery, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo 183-0003, Japan; and yDepartment of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo 183-0003, Japan ABSTRACT Background and aim of the study: We retrospectively studied outcomes after mitral annuloplasty (MAP) combined with subvalvular procedures for patients with functional mitral regurgitation and ischemic dilated cardiomyopathy. We focused on changes in mitral regurgitation (MR) grade, mitral valve tethering, and left ventricular (LV) volume before and after surgery. Methods: Thirty-one patients underwent MAP combined with subvalvular procedures including papillary muscle (PM) approximation, PM relocation, and chordal cutting. Fifteen patients underwent left ventriculoplasty. Twenty patients underwent PM approximation, and 11 patients underwent PM relocation. Two patients underwent chordal cutting in addition to PM approximation or relocation. In 25 patients, echocardiographic measurements of MR grade, mitral valve tethering, and LV volume were compared among three time points: before, immediately after, and one year after surgery. Results: There were no in-hospital deaths. LV volume as well as both tenting height and area were significantly reduced immediately after and at one year after surgery. Five patients developed recurrent MR at one year after surgery. In comparison with the other 20 patients, the preoperative MR grade was significantly higher (p = 0.018). The postoperative reduction of LV volume was significant in patients without recurrent MR. Conclusions: Both tenting height and area could be significantly reduced and maintained after MAP combined with subvalvular procedures. The preoperative MR grade and the presence of a large postoperative LV volume were more likely to result in recurrent MR. However, among patients with recurrent MR, the MR grade does not increase during mid-term follow-up. doi: 10.1111/jocs.12459 (J Card
Surg 2015;30:27–34)
Functional mitral regurgitation (FMR) is a complex and formidable problem that influences early and late outcomes following cardiac surgery. In patients with ischemic cardiomyopathy, even a mild degree of FMR adversely affects survival.1,2 Restrictive mitral annuloplasty (MAP) combined with coronary artery bypass grafting (CABG) is the most frequent surgical treatment for FMR. However, higher rates of recurrent mitral regurgitation (MR) have been reported in patients treated with restrictive MAP alone. FMR is not a valvular disease, but rather a ventricular problem Conflict of interest: The authors acknowledge no conflict of interest in the submission. Address for correspondence: Yasuyuki Kato, Department of Cardiovascular Surgery, Sakakibara Heart Institute, 3-16-1, Asahi-cho, Fuchu, Tokyo 183-0003, Japan. Fax: þ81-42-314-3199; e-mail: [email protected]
resulting from leaflet tethering caused by papillary muscle (PM) displacement and annular dilatation after myocardial infarction.3–8 Restrictive MAP displaces the posterior annulus anteriorly, leading to significant posterior leaflet tethering. This phenomenon is considered to be the main cause of persistent or recurrent MR after restrictive MAP. Recently, several surgical procedures of the mitral valve leaflets, chordae tendineae, PMs, and left ventricle (LV) to correct leaflet tethering have been reported.9–15 Among those procedures, we performed chordal cutting, PM approximation, and PM relocation in selected patients. This study retrospectively reviewed the outcomes after surgery using these techniques with or without left ventriculoplasty for the treatment of FMR with ischemic cardiomyopathy. Using echocardiography, we also investigated early and late changes in MR grade, mitral valve tethering, and LV volume after surgery.
28
KATO, ET AL. SURGERY FOR FMR INVOLVING SUBVALVULAR APPARATUS
MATERIALS AND METHODS Patient population Between December 2004 and December 2012, 58 patients with ischemic cardiomyopathy with an ejection fraction (EF) of 0.999 >0.999 0.0887 0.101 0.226 >0.999 0.611 >0.999 0.179
BSA, body surface area; NYHA, New York Heart Association; DM, diabetes mellitus; DL, dyslipidemia; PVD, peripheral vascular disease; CVD, cerebral vascular disease; HD, hemodialysis; COPD, chronic obstructive pulmonary disease; Af, atrial fibrillation; PCI, percutaneous coronary intervention; HF, heart failure.
J CARD SURG 2015;30:27–34
KATO, ET AL. SURGERY FOR FMR INVOLVING SUBVALVULAR APPARATUS
29
TABLE 2 Operative Data All (n = 31) Ring Physio Saddle Physio II Ring size 24 26 28 30 32 Subvalvular procedure PM approximation þSuspension þChordal cutting PM relocation Posterior PM only Both PMs CABG (No. of anastomosis) Left ventriculoplasty SAVE Overlapping Linear closure Other procedures TV surgery Others Cardiac arrest time (min) CPB time (min) Operation time (min)
M Group (n = 16)
LV Group (n = 15)
P Value
19 1 11
9 0 7
10 1 4
0.398
1 8 9 7 6
0 5 4 3 4
1 3 5 4 2
0.664
20 3 2 11 3 8 3.4 1.6
8 2 1 8 3 5 3.5 1.3
6 6 3 6 4 120 51 195 54 380 85
12 1 1 3 0 3 3.1 1.8
0.135
0.516
6 6 3 4 2 122 48 182 59 376 97
2 2 119 57 207 45 386 75
0.654 >0.999 0.866 0.186 0.746
PM, papillary muscle; CABG, coronary artery bypass grafting; No., number; SAVE, septal anterior ventricular exclusion; TV, tricuspid valve, CPB, cardiopulmonary bypass.
PM approximation was performed in eight patients in the M group and 12 patients in the LV group, and PM relocation was performed in eight patients in the M group (both PMs in five patients and posterior PM only in three patients) and three patients in the LV group (both PMs in all patients). Chordal cutting was also performed for the medial aspect of the posterior leaflet in one patient in the M group, and for the middle of the posterior leaflet in one patient in the LV group. In three patients (two in the M group and one in the LV group), the approximated PMs were suspended in the central portion of the anterior mitral annulus to fix the distance between the approximated PM heads and the mitral annulus, using a pair of 3-0 polypropylene sutures that were attached proximal to the mitral annulus for approximating the PMs.
patients. One patient who underwent mitral valve replacement at one month after the initial operation was excluded from late follow-up study. LV end-diastolic volume, end-systolic volume, and EF were determined using the modified biplane Simpson’s method. The grade of MR was assessed according to the size and distance of the regurgitant jet. MR grades were as none (0), mild (1), mild to moderate or moderate (2), moderate to severe (3) or severe (4). All MR grade was assessed under the condition in which heart failure was medically managed. The tenting height (defined as the distance between the annulus and the coaptation point of the mitral leaflets), and the tenting area (defined as the area outlined by the annulus and leaflets) were measured in mid-systole in the parasternal long-axis view. Follow-up
Echocardiographic examinations Two-dimensional and Doppler echocardiography was performed in all patients using an HP Sonos system (Hewlett-Packard Co., Andover, MA, USA) before and one week after surgery. Quantitative analyses were conducted by experienced echocardiographers and reviewed by two cardiologists. Follow-up echocardiography was performed at one year after surgery in 25 patients (11 patients in the M group and 14 patients in the LV group), and changes in MR grade, mitral valve tethering, and LV volume were evaluated in these 25
The medical records were reviewed to obtain mortality and morbidity data. Postoperative complications included low cardiac output (a newly placed intraaortic balloon pump, or use of dopamine or dobutamine >5 mg/kg/min), ventricular tachycardia or fibrillation, bleeding requiring re-exploration, and respiratory failure (intubation time >48 hours). Follow-up information was collected by direct patient evaluations and telephone interviews. Unsuccessful attempts to trace patients were followed by contact with a family member or the referring physician.
30
KATO, ET AL. SURGERY FOR FMR INVOLVING SUBVALVULAR APPARATUS
J CARD SURG 2015;30:27–34
Statistical analysis All data were analyzed using StatView software version 5.0 (SAS Institute, Inc., Cary, NC, USA). Continuous variables are presented as mean standard deviation, and categorical variables are presented as absolute numbers and percentages. Data were checked for normality before statistical analysis. Normally distributed continuous variables were compared using the unpaired or paired t-test, and non-normally distributed variables were compared using the Mann–Whitney U-test or Wilcoxon signed-rank test. Categorical variables were analyzed using the x2 test or Fisher’s exact test. Changes in echocardiographic parameters over time were analyzed by repeated-measures analysis of variance, followed by the Tukey–Kramer test or Friedman’s test, as appropriate. Patient survival, freedom from cardiac-related death, and freedom from CHF requiring hospitalization were determined by the Kaplan–Meier method. Survival rates were compared between groups using the log-rank test. p < 0.05 was considered statistically significant. RESULTS Operative mortality and morbidity Early postoperative outcomes are shown in Table 3. There were no in-hospital deaths. One patient who underwent MAP with PM approximation and left ventriculoplasty required mitral valve replacement for recurrence of MR because of chordal rupture at one month after the initial operation. Low output syndrome (newly placed intraaortic balloon pump or the use of dopamine or dobutamine at doses over 5 g/kg/min) occurred in five patients. Temporary ventricular tachycardia or fibrillation occurred in two patients, and one patient required re-exploration for bleeding. Two patients required prolonged ventilation. Patient survival, freedom from cardiac death, and freedom from heart failure One patient was lost to follow-up, resulting in a follow-up rate of 96.8% (30 of 31 patients) with a mean follow-up time of 2.8 1.8 years (range 0.1 to 7.0 years). There were five late deaths in the M group and one in the LV group. One of the patients in the M group
Figure 1. Overall survival.
died of CHF, and the other four deaths were not cardiacrelated. CHF requiring hospitalization occurred in two patients in the M group and two in the LV group; none of these four patients had more than grade 2 postoperative MR. The overall three-year survival rate was 77% in the M-group and 86% in the LV group (p ¼ 0.256, Fig. 1), respectively. There were no significant difference about the three-year rate of freedom from cardiac-related death (p > 0.999) or the three-year rate of freedom from CHF requiring hospitalization (p ¼ 0.668) between patients in the M group and the LV group. Echocardiographic evaluations Immediately after surgery, mild MR was observed in three patients and moderate MR was observed in one patient. In three of these four patients, echocardiography at one year after surgery did not show a change in MR grade, and in the other patient (who had mild postoperative MR) echocardiographic data were not available at one year. Follow-up echocardiography was performed at one year after surgery in 25 patients (11 in the M group and 14 in the LV group). The echocardiographic data obtained before surgery, immediately (one week) after surgery, and at one year after surgery are shown in Table 4. MR grade was significantly reduced in both groups immediately after surgery and remained similar at one year after surgery. Grade 2 MR was observed in two patients at one year after surgery (recurrence rate of grade 2 or greater MR: 8%).
TABLE 3 Early Results
Operative results Hospital death Complications Recurrence of MR (torn chordae) Low output syndrome Bleeding Respiratory failure Vt or Vf Atrial fibrillation
All (n = 31)
M Group (n = 16)
LV Group (n = 15)
P Value
0
0
0
N/A
1 5 1 2 2 10
1 2 0 2 1 6
0 3 1 0 1 4
0.484 0.654 0.484 0.484 >0.999 0.704
MR, mitral regurgitation; Vt, ventricular tachycardia; Vf, ventricular fibrillation.
J CARD SURG 2015;30:27–34
KATO, ET AL. SURGERY FOR FMR INVOLVING SUBVALVULAR APPARATUS
31
TABLE 4 Echocardiographic Data of Preoperative, Early Postoperative, and One Year After Surgery in Each Group Variables LVEDD (mm) LVESD (mm) EF (%) LVEDV (mL) LVESV (mL) LVEDVI (mL/m2) LVESVI (mL/m2) Tenting height (mm) Tenting area (cm2) Tricuspid regurgitant pressure gradient (mmHg) MR grade
Groups
Pre
Post
One year
P Value
M LV M LV M LV M LV M LV M LV M LV M LV M LV M LV M LV
62.4 7.1 66.4 7.6 53.5 7.4 57.4 10.6 28.0 5.9 23.4 7.4 203 59 255 67 148 49 197 60 128 29 158 51 93 24 122 44 9.5 2.5 10.0 2.2 1.3 0.5 1.5 0.5 33 9 37 15 2.0 0.9 1.8 0.7
58.7 8.8 60.8 9.0 49.8 10.6 50.9 10.5 29.6 6.1 29.0 8.2 170 64 159 48 122 55 115 46 106 33 97 30 76 29 70 29 6.5 1.1 6.6 2.0 0.6 0.1 0.6 0.2 26 6 31 10 0.3 0.6 0.1 0.3
56.8 8.8 60.2 9.5 47.6 9.8 49.1 12.1 34.2 9.8 30.5 8.7 171 68 167 48 117 57 119 45 107 36 102 31 72 30 72 28 6.5 1.0 5.2 1.9 0.6 0.2 0.5 0.2 29 14 38 18 0.5 0.8 0.3 0.5
0.019#
