Carlo Fino MD Carlo Fino MD Cardiovascular Department Azienda Ospedaliera Papa Giovanni XXIII Bergamo, Italy Mechanical versus Biological Prostheses for Chronic Ischaemic Mitral Regurgitation: A Long-Term Hemodynamic and Functional Capacity Comparison
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Carlo Fino MDCarlo Fino MDCardiovascular Department
Azienda Ospedaliera Papa Giovanni XXIIIBergamo, Italy
Mechanical versus Biological Prostheses for Chronic Ischaemic Mitral Regurgitation: A Long-Term Hemodynamic and Functional Capacity
Comparison
Background
• Chronic ischemic mitral regurgitation is a common complication in patients with coronary artery disease
• The outcome is poor
• The treatment is still debated
Lamas et al Circulation 1997 Magne et a Circulation 2009Lorusso et al JTCVS 2013
COR: Class of Recommendation LOE: level of Evidence
Summary of Recommendations for Chronic Severe Ischemic MR
AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease, JACC 2014
…Replacement provided a more durable correction of mitral regurgitation, but there was no significant between-group difference in clinical outcomes…
Acker M.A et al
Complete chordal-sparing mitral valve replacement
Pibarot P et al, Heart 2006
•6-MWT is a practical, simple, inexpensive test, which does not require any exercise equipment.
•It has been proposed both as a functional status indicator and as an outcome measure in various categories of patients (i.e postcardiac surgery)
•Coupled with exercise stress echocardiography, is able to accurately assess global cardiovascular function, specifically in patients with LV dysfunction
Demers et al, Am Heart J 2001 Picano et al, Heart 2013 Rostagno et al, Intern Emerg Med 2008
Cardiovascular Assessment
Aim of the Study
Long-term global cardiovascular performance
assessed by ESE and 6-MWT, in patients with
ischaemic mitral regurgitation referred to valve
replacement with Bio prostheses, compared to
replacement with Mech prostheses.
.
Preoperative Data
M: mechanical prostheses; B: biological prostheses; BSA: body surface area; VC: vena contracta; 6-MWT: six-minute walking test