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Risk Factors for Post-Repair Elevated Mitral Gradient: A Post-Hoc Analysis of a Randomized Trial.

Authors:
Makoto Hibino Arjun Pandey Vincent Chan C David Mazer Rawan Rumman Nitish K Dhingra Christopher Bonneau Raj Verma Yujiro Yokoyama Adrian Quan Hwee Teoh Asim Cheema Benoit E de Varennes Bobby Yanagawa Howard Leong-Poi Kim A Connelly Gianluigi Bisleri Subodh Verma

Ann Thorac Surg 2022 Jun 29. Epub 2022 Jun 29.

Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Department of Surgery, University of Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, ON, Canada. Electronic address:

Background: Pre-discharge elevated mean mitral gradients (>5mmHg) may occur after repair for degenerative mitral regurgitation. We sought to identify risk factors associated with elevated gradients as well as to evaluate its impact on functional outcomes at 12 months in this sub-analysis of the Canadian Mitral Research Alliance (CAMRA) CardioLink-2 trial.

Methods: 104 degenerative mitral regurgitation patients undergoing mitral repair were randomized to either a leaflet resection or preservation strategy. Logistic regression was used to identify risk factors associated with an elevated gradient. Functional outcomes at 12 months were compared between participants with and without elevated gradients.

Results: Elevated gradients was identified in 15 participants (14.4%), which was not significantly different based on allocation to each repair strategy (p=0.10). Patients with elevated gradients were more likely to be female (OR 4.28 [95%CI:1.29-14.19] p=0.02) and had a lower preoperative hemoglobin level (0.93 [0.89-0.98] p=0.01) and smaller inter-commissural diameter (0.86 [0.76-0.97] p=0.02) and mitral annuloplasty size (0.71 [0.57-0.87] p=0.001). The ratio of inter-commissural diameter to annuloplasty size was similar between those with and without elevated gradients (both 0.8±0.1; p=0.69). At 12 months, those with elevated gradients had worse NYHA functional status (p=0.0001), lower peak oxygen saturation in exercise test (p=0.01), smaller body weight-walk distance product (p=0.02) and higher Borg Scale (p=0.01) in 6-minute walk test.

Conclusions: Female gender, smaller mitral anatomy sizes and lower preoperative hemoglobin levels were associated postoperative elevated mitral gradients, which was in turn associated with reduced functional status. Further research is warranted to investigate these potential risk factors.

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http://dx.doi.org/10.1016/j.athoracsur.2022.05.053DOI Listing
June 2022

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