MRI as a Predictor of Outcomes in Patients Undergoing Mitral Valve Surgery
MRI as a Predictor of Outcomes in Patients Undergoing Mitral Valve Surgery
Based on the ACC/AHA guidelines for the management of mitral valve disease, quantifying the
 severity of mitral regurgitation is central to determining which patients are appropriate for
 correction of their mitral valve by surgery. Specifically, once the diagnosis of severe MR is
 made, patients are considered appropriate for mitral valve surgery in almost all clinical
 circumstances. However, there is a significant mortality and morbidity associated with mitral
 valve surgery The most common diagnostic tool to assess the severity of MR is
 echocardiography. Several studies have shown that echocardiography parameters used to
 quantify and qualify MR have high inter-observer and intra-observer variability, calling the
 accuracy of these parameters into question. Furthermore, studies have shown that there is a
 significant degree of discordance between echocardiography and MRI when assessing MR,
 particularly among patients referred for mitral valve surgery. In a recent study,
 quantification of mitral regurgitant volume MRI was found to be more accurate than
 echocardiography in patients who underwent mitral valve surgery. All 38 patients who
 underwent mitral valve surgery in this study were deemed appropriate according the ACC/AHA
 guidelines based on echocardiographic findings. However, more than 2/3rds of patients who
 underwent mitral valve surgery in this study did not have severe MR by MRI. Thus, we propose
 this prospective multicenter trial to assess: 1) the severity of MR by MRI in patients
 undergoing mitral valve surgery. 2) the impact of mitral valve surgery on quality of life and
 healthcare costs in the context of MR severity by MRI, 3) assess patient outcomes post
 surgery in the context of MR severity by MRI and 4) the likelihood of valve replacement vs.
 repair according to MR severity by MRI.
Mitral regurgitation is a common disease which can lead to heart failure and death if left
 untreated. The only known therapy for mitral regurgitation is correction of the mitral valve,
 most commonly performed by surgical repair or replacement. According the STS database, there
 were 15,748 lone mitral valve surgeries in 2014. The number of mitral valve surgeries has
 been increasing with a 23% increase between the years 2010 and 2014. Based on the ACC/AHA
 guidelines for the management of mitral valve disease, quantifying the severity of mitral
 regurgitation is central to determining which patients are appropriate for correction of
 their mitral valve by surgery. Specifically, once the diagnosis of severe MR is made,
 patients are considered appropriate for mitral valve surgery in almost all clinical
 circumstances. However, there is a significant mortality and morbidity associated with mitral
 valve surgery. In the STS database, 30 day mortality was ~2% for repair and ~5% for
 replacement. This data does not take into account long-term mortality and morbidity from
 re-operation and life-long anti-coagulation as well as changes in quality of life.

 The most common diagnostic tool to assess the severity of MR is echocardiography. Several
 studies have shown that echocardiography parameters used to quantify and qualify MR have high
 inter-observer and intra-observer variability, calling the accuracy of these parameters into
 question. Furthermore, studies have shown that there is a significant degree of discordance
 between echocardiography and MRI when assessing MR, particularly among patients referred for
 mitral valve surgery. In a recent study, quantification of mitral regurgitant volume MRI was
 found to be more accurate than echocardiography in patients who underwent mitral valve
 surgery. All 38 patients who underwent mitral valve surgery in this study were deemed
 appropriate according the ACC/AHA guidelines based on echocardiographic findings. However,
 more than 2/3rds of patients who underwent mitral valve surgery in this study did not have
 severe MR by MRI. Thus, we propose this prospective multicenter trial to assess: 1) the
 severity of MR by MRI in patients undergoing mitral valve surgery. 2) the impact of mitral
 valve surgery on quality of life and healthcare costs in the context of MR severity by MRI,
 3) assess patient outcomes post surgery in the context of MR severity by MRI and 4) the
 likelihood of valve replacement vs. repair according to MR severity by MRI.
Inclusion Criteria:

 -  Age 18 years and older.

 -  Able to give informed consent.

 -  Undergoing lone mitral valve surgery for chronic primary mitral regurgitation within
 30 days.

 -  Indication for mitral valve surgery is a class I or IIa according to the 2014 ACC/AHA
 guidelines for the management of valvular heart disease.

 Exclusion Criteria:

 -  Secondary mitral regurgitation.

 -  Have a device which is not compatible with MRI

 -  Claustrophobia preventing MRI.

 -  Concomitant CABG, other valve surgery, or other cardiac surgery.

 -  Atrial fibrillation or other substantial arrhythmia that would substantially degrade
 MRI image acquisition.