013RESTRICTIVE MITRAL ANNULOPLASTY DOES NOT LIMIT EXERCISE CAPACITY

• Published in: Interactive cardiovascular and thoracic surgery Vol. 17; no. suppl_2; p. S72
• Main Authors: Deja, M.A., Żak, A., Pysz, P., Turski, M., Gaszewska-Żurek, E., Malinowski, M., Janusiewicz, P., Wita, K.
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.10.2013
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt372.13

Objectives: To determine whether restrictive mitral annuloplasty for secondary mitral regurgitation induces mitral stenosis and affects the exercise capacity of the patient. Methods: Thirty-six patients who underwent restrictive mitral annuloplasty with a Carpentier-Edwards classic 26 size ring were subjected to exercise echocardiography and spiro-ergometry. Resting catecholamines and NT-proBNP levels were measured. Results: The median time from operation was 17 months (Q1-Q3 8-43). The median left ventricular end systolic volume was 108 ml (45.5-188.5) and ejection fraction was 38.8% (28.3-59.0). Trivial/mild mitral regurgitation was present in 12 patients, moderate in three patients and severe in one patient. Mitral valve gradients, measured with continuous wave Doppler at rest, were 3.4 mmHg (2.4-4.9) mean and 9.5 mmHg (7.0-14.7) maximum. On exertion, they increased to 6.8 mmHg (5.4-8.8) (P = 0.001) and 19.7 mmHg (12.8-23.3) (P = 0.001) respectively. On spiro-ergometry, maximum VO2 was 18.2 ml/kg/min (16.3-21.5). The energy expenditure was 5.8 MET (4.0-7.8). Epinephrine level was 0.024 ng/ml (0.0098-0.043), norepinephrine 0.61 ng/ml (0.41-0.95), and NT-proBNP 303 pg/ml (155-553). Energy expenditure on spiro-ergometry negatively correlated with norepinephrine (r= -0.47, P = 0.007) and NT-proBNP level (r= -0.36, P = 0.04). Maximum VO2 negatively correlated with norepinephrine level (r= -0.50; P = 0.003). We failed to find correlation of both maximum VO2 and energy expenditure with left ventricular volumes and ejection fraction. Similarly, there was no correlation of maximum VO2 with the highest mean (r = 0.24, P = 0.2) and maximum (r = 0.13, P = 0.5) mitral valve gradients on exertion. Nevertheless, the highest mean mitral valve gradient on exertion correlated with patient energy expenditure on spiro-ergometry (r = 0.4, P = 0.03). Conclusions: Although restrictive mitral annuloplasty results in mitral gradients which rise significantly with exertion, they do not seem to limit the exercise capacity of the patient.