{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:51:30Z","timestamp":1774572690140,"version":"3.50.1"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2019,6,16]],"date-time":"2019-06-16T00:00:00Z","timestamp":1560643200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>The risk factors and clinical effect of elevated mitral valve (MV) gradients after valve repair for degenerative valve disease remain insufficiently understood.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Between January 2004 and December 2015, a total of 484 patients underwent valve repair for degenerative disease. A true-sized full annuloplasty ring was implanted in all cases. We analysed the effect of preoperative and intraoperative factors on the postrepair gradient. Additionally, we explored the effect of postrepair gradients on long-term outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>On linear regression analysis, postrepair MV gradients were associated with patient age (coefficient\u2009=\u2009\u22120.110, standard error\u2009=\u20090.005, P\u2009=\u20090.034), body surface area (coefficient\u2009=\u20090.905, standard error\u2009=\u20090.340, P\u2009=\u20090.008), implanted annuloplasty ring size (coefficient\u2009=\u2009\u22120.181, standard error\u2009=\u20090.018, P\u2009&amp;lt;\u20090.001) and the use of Physio I ring (coefficient\u2009=\u20090.414, standard error\u2009=\u20090.122, P\u2009=\u20090.001). On multivariable analysis, postrepair MV gradient was not associated with overall survival [hazard ratio (HR) 1.034, 95% confidence interval (CI) 0.889\u20131.203; P\u2009=\u20090.66] or freedom from atrial fibrillation (HR 0.849, 95% CI 0.682\u20131.057; P\u2009=\u20090.14), but did emerge as a risk factor for MV reintervention (HR 1.378, 95% CI 1.033\u20131.838; P\u2009=\u20090.029). Two out of 11 reinterventions were performed due to MV stenosis and in both patients, high postrepair gradients were seen readily on predischarge echocardiography.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Following valve repair for degenerative MV disease, elevated gradients occur even when true-sized annuloplasty is performed. The late clinical results of valve repair with elevated postrepair gradient are impaired and further studies are needed to explore preventive measures aimed at resolving the issue.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezz178","type":"journal-article","created":{"date-parts":[[2019,5,16]],"date-time":"2019-05-16T23:17:22Z","timestamp":1558048642000},"page":"293-299","source":"Crossref","is-referenced-by-count":11,"title":["Risk factors and clinical significance of elevated mitral valve gradient following valve repair for degenerative disease"],"prefix":"10.1093","volume":"57","author":[{"given":"Anton","family":"Tom\u0161i\u010d","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasmine L","family":"Hiemstra","sequence":"first","affiliation":[{"name":"Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bardia","family":"Arabkhani","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5019-0354","authenticated-orcid":false,"given":"Bart J A","family":"Mertens","sequence":"first","affiliation":[{"name":"Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas J","family":"van Brakel","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michel I M","family":"Versteegh","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nina Ajmone","family":"Marsan","sequence":"first","affiliation":[{"name":"Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6507-3855","authenticated-orcid":false,"given":"Robert J M","family":"Klautz","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7213-5452","authenticated-orcid":false,"given":"Meindert","family":"Palmen","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,6,15]]},"reference":[{"key":"2020021910593166200_ezz178-B1","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.jtcvs.2011.12.054","article-title":"A near 100% repair rate for mitral valve prolapse is achievable in a reference center: implications for future guidelines","volume":"144","author":"Castillo","year":"2012","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020021910593166200_ezz178-B2","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1161\/CIRCULATIONAHA.112.000699","article-title":"Late outcomes of mitral valve repair for mitral regurgitation due to degenerative disease","volume":"127","author":"David","year":"2013","journal-title":"Circulation"},{"key":"2020021910593166200_ezz178-B3","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1161\/CIRCIMAGING.112.000688","article-title":"Functional significance of elevated mitral gradients after repair for degenerative mitral regurgitation","volume":"6","author":"Chan","year":"2013","journal-title":"Circ Cardiovasc Imaging"},{"key":"2020021910593166200_ezz178-B4","doi-asserted-by":"crossref","first-page":"1692","DOI":"10.1016\/j.jacc.2007.11.082","article-title":"Restrictive annuloplasty for ischemic mitral regurgitation may induce functional mitral stenosis","volume":"51","author":"Magne","year":"2008","journal-title":"J Am Coll Cardiol"},{"key":"2020021910593166200_ezz178-B5","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1016\/j.jtcvs.2013.08.011","article-title":"Clinical evaluation of functional mitral stenosis after mitral valve repair for degenerative disease: potential affect on surgical strategy","volume":"146","author":"Mesana","year":"2013","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020021910593166200_ezz178-B6","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1016\/j.jtcvs.2007.12.002","article-title":"Guidelines for reporting mortality and morbidity after cardiac valve interventions","volume":"135","author":"Akins","year":"2008","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020021910593166200_ezz178-B7","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.athoracsur.2005.07.083","article-title":"Atrial incision affects the incidence of atrial tachycardia after mitral valve surgery","volume":"81","author":"Lukac","year":"2006","journal-title":"Ann Thorac Surg"},{"key":"2020021910593166200_ezz178-B8","doi-asserted-by":"crossref","first-page":"2463","DOI":"10.1093\/eurheartj\/ehi426","article-title":"Recommendations for the management of patients after heart valve surgery","volume":"26","author":"Butchart","year":"2005","journal-title":"Eur Heart J"},{"key":"2020021910593166200_ezz178-B9","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1067\/mtc.2001.116313","article-title":"Three-dimensional geometric comparison of partial and complete flexible mitral annuloplasty rings","volume":"122","author":"Dagum","year":"2001","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020021910593166200_ezz178-B10","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.ejcts.2010.02.011","article-title":"How do annuloplasty rings affect mitral leaflet dynamic motion?","volume":"38","author":"Bothe","year":"2010","journal-title":"Eur J Cardiothorac Surg"},{"key":"2020021910593166200_ezz178-B11","first-page":"536","article-title":"Long-term outcomes after mitral ring annuloplasty for degenerative mitral regurgitation: Duran ring versus Carpentier-Edwards ring","volume":"16","author":"Chung","year":"2007","journal-title":"J Heart Valve Dis"},{"key":"2020021910593166200_ezz178-B12","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1016\/j.jtcvs.2015.07.019","article-title":"Assessment of mitral annuloplasty ring by cardiac computed tomography: correlation with echocardiographic parameters and comparison between two different ring types","volume":"150","author":"Suh","year":"2015","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020021910593166200_ezz178-B13","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.jtcvs.2015.08.078","article-title":"Mitral valve gradient after valve repair of degenerative regurgitation with restrictive annuloplasty","volume":"151","author":"Murashita","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020021910593166200_ezz178-B14","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.jtcvs.2017.07.078","article-title":"Systematic review and meta-analysis of chordal replacement versus leaflet resection for posterior mitral leaflet prolapse","volume":"155","author":"Mazine","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020021910593166200_ezz178-B15","first-page":"111","article-title":"Excessive leaflet tissue in mitral valve repair for isolated posterior leaflet prolapse-leaflet resection or shortening neochords? A propensity score adjusted comparison","volume":"60","author":"Tom\u0161i\u010d","year":"2019","journal-title":"J Cardiovasc Surg (Torino)"},{"key":"2020021910593166200_ezz178-B16","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1016\/j.jtcvs.2017.10.038","article-title":"Revisiting posterior mitral leaflet prolapse: resect, respect, or resect with respect?","volume":"155","author":"Antunes","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020021910593166200_ezz178-B17","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1016\/j.jtcvs.2017.09.085","article-title":"Respect versus resect: two different repair techniques or two different tools in the toolbox?","volume":"155","author":"Tom\u0161i\u010d","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020021910593166200_ezz178-B18","doi-asserted-by":"crossref","first-page":"1856","DOI":"10.1016\/j.jtcvs.2018.05.017","article-title":"\u201cRespect when you can, resect when you should\u201d: a realistic approach to posterior leaflet mitral valve repair","volume":"156","author":"Dreyfus","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020021910593166200_ezz178-B19","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1093\/ejcts\/ezy062","article-title":"Functional mitral stenosis after mitral valve repair for type II dysfunction: determinants and impacts on long-term outcome","volume":"54","author":"Kawamoto","year":"2018","journal-title":"Eur J Cardiothorac Surg"},{"key":"2020021910593166200_ezz178-B20","article-title":"Elevated gradient after mitral valve repair: the effect of surgical technique and relevance of postoperative atrial fibrillation","author":"Ma","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020021910593166200_ezz178-B21","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.ahj.2010.10.029","article-title":"Left atrial reverse remodeling and functional improvement after mitral valve repair in degenerative mitral regurgitation: a real-time 3-dimensional echocardiography study","volume":"161","author":"Marsan","year":"2011","journal-title":"Am Heart J"},{"key":"2020021910593166200_ezz178-B22","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1111\/j.1540-8167.2011.02187.x","article-title":"Differential structural remodeling of the left-atrial posterior wall in patients affected by mitral regurgitation with or without persistent atrial fibrillation: a morphological and molecular study","volume":"23","author":"Corradi","year":"2012","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2020021910593166200_ezz178-B23","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.amjcard.2017.03.242","article-title":"Mitral valve repair for pure mitral regurgitation followed years later by mitral valve replacement for mitral stenosis","volume":"120","author":"Becker","year":"2017","journal-title":"Am J Cardiol"},{"key":"2020021910593166200_ezz178-B24","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.jtcvs.2007.06.040","article-title":"Durability of mitral valve repair in Barlow disease versus fibroelastic deficiency","volume":"135","author":"Flameng","year":"2008","journal-title":"J Thorac Cardiovasc Surg"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/57\/2\/293\/32523611\/ezz178.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/57\/2\/293\/32523611\/ezz178.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,2,19]],"date-time":"2020-02-19T11:52:42Z","timestamp":1582113162000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/57\/2\/293\/5519363"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,15]]},"references-count":24,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,6,15]]},"published-print":{"date-parts":[[2020,2,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezz178","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,2]]},"published":{"date-parts":[[2019,6,15]]}}}