Predicting recurrent mitral regurgitation after mitral valve repair for severe ischemic mitral regurgitation Irving L. Kron, MD, Judy Hung, MD, Jessica.

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Predicting recurrent mitral regurgitation after mitral valve repair for severe ischemic mitral regurgitation Irving L. Kron, MD, Judy Hung, MD, Jessica R. Overbey, MS, Denis Bouchard, MD, Annetine C. Gelijns, PhD, Alan J. Moskowitz, MD, Pierre Voisine, MD, Patrick T. O'Gara, MD, Michael Argenziano, MD, Robert E. Michler, MD, Marc Gillinov, MD, John D. Puskas, MD, James S. Gammie, MD, Michael J. Mack, MD, Peter K. Smith, MD, Chittoor Sai-Sudhakar, MD, Timothy J. Gardner, MD, Gorav Ailawadi, MD, Xin Zeng, MD, Karen O'Sullivan, MPH, Michael K. Parides, PhD, Roger Swayze, RN, BSN, Vinod Thourani, MD, Eric A. Rose, MD, Louis P. Perrault, MD, Michael A. Acker, MD The Journal of Thoracic and Cardiovascular Surgery Volume 149, Issue 3, Pages 752-761.e1 (March 2015) DOI: 10.1016/j.jtcvs.2014.10.120 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Echocardiographic measures of MV tethering. A, MV tenting area (hashmark area) and MV tenting height (gold arrow). B, Anterior and posterior leaflet angle measurements (yellow angle). LA, Left atrium; LV, left ventricle. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 752-761.e1DOI: (10.1016/j.jtcvs.2014.10.120) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Tethering mechanism for recurrent MR after repair. Mitral leaflets remain tethered (large arrows) after MV ring annuloplasty (small arrows show ring) with moderate MR (blue and red color flow). The Journal of Thoracic and Cardiovascular Surgery 2015 149, 752-761.e1DOI: (10.1016/j.jtcvs.2014.10.120) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A, Moderate/severe MR at different time intervals. This bar graph depicts patients who were alive and had documented moderate/severe MR recurrence at that time point. Patients with missing echocardiograms are not included. B, Patients experiencing moderate/severe MR recurrence or death over 2 years. This histogram shows the cumulative proportion of patients who had moderate/severe MR recurrence or death at any point over the 2-year follow-up period. The denominator is 116 patients. MR, Mitral regurgitation. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 752-761.e1DOI: (10.1016/j.jtcvs.2014.10.120) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Basal aneurysm. Inferior basal aneurysm delineated by black arrows. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 752-761.e1DOI: (10.1016/j.jtcvs.2014.10.120) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 ROC curves of fitted models. A, ROC generated by reduced model of recurrence and/or death. B, ROC generated by fitted model of recurrence alone. AUC, Area under the curve. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 752-761.e1DOI: (10.1016/j.jtcvs.2014.10.120) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Basal aneurysm/dyskinesis is an important predictor of recurrent MR after ischemic MR repair. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 752-761.e1DOI: (10.1016/j.jtcvs.2014.10.120) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions