Abstract 19592: Posterior Leaflet Tethering Correlates With LV Size to MV Ring Mismatch for MV Repair in Ischemic Mitral Regurgitation: Mechanistic and Clinical Insights for Recurrence of Ischemic Mitral Regurgitation Post Restrictive Ring Annuloplasty

Background: The ratio of LV end-systolic dimension (LVESd)/mitral valve (MV) ring size (LV-MV Ring Mismatch) has been shown to be associated with recurrent ischemic mitral regurgitation (IMR) after restrictive annuloplasty. We aimed to examine the effect of MV repair on MV tethering and correlate changes in MV tethering to degree of LV-MV mismatch, hypothesizing that persistent posterior leaflet tethering post annuloplasty is the underlying mechanism for the association between LVESd/MV ring ratio and recurrent IMR. Methods: Patients from two Cardiothoracic Surgical Trials Network (CTSN) IMR trials who underwent ring annuloplasty with complete echo data and with appropriate image quality for quantification at 1 yr post annuloplasty were eligible (154 out of 276 patients) MV tethering geometry (tenting height and area, and posterior/anterior leaflet angles) were measured at baseline and 1 year post annuloplasty. LVESd/MV ring ratio was sub grouped into quartiles. Results: Restrictive annuloplasty was assoc...