OBJECTIVE: Remodeling of the left ventricle (LV) in ischemic cardiomyopathy frequently leads to functional mitral regurgitation (MR). The indication for correcting MR in patients undergoing LV reconstruction (LVR) is unclear. In this study, we evaluated our strategy of correcting MR≥grade 2+ by restrictive mitral annuloplasty (RMA) during LVR. METHODS: We studied 92 consecutive patients (76 men, mean age 61±10 years) who underwent LVR for ischemic heart failure (IHF). RMA was performed in all patients with MR≥grade 2+ on preoperative echocardiography and in patients who showed increased MR to ≥grade 2+ immediately after LVR. Patients were attributed to a RMA and no-RMA group, depending on whether or not concomitant RMA had been performed. Mean clinical and structured echocardiographic follow-up was 47±20 months and was 100% complete. RESULTS: In 38 out of 40 patients (95%) with preoperative MR≥grade 2+, concomitant RMA was planned and performed. In 17 out of 52 patients (33%) with MR<grade 2+ preoperatively, MR increased after LVR to ≥grade 2+ leading to additional RMA during a second period of aortic cross-clamping. Early mortality in the RMA group (n=55) was 12.7% and survival at 36 months 78.2±11.2%. Early mortality in the no-RMA group (n=37) was 5.4% and survival at 36 months 81.1±12.8%. Patients in the RMA group had significantly more reduced LV function with greater LV dimensions and volumes preoperatively. Echocardiography demonstrated sustained improvement in LVEF with reduction of LV volumes in both patient groups. Recurrence of MR at late follow-up was observed in 2 patients (1 patient per group). CONCLUSIONS: Patients with IHF eligible for LV reconstruction have MR≥grade 2+ in 44% of cases. In one-third of IHF patients with MR<grade 2+ preoperatively, MR increases to ≥grade 2+ after LVR. Concomitant mitral valve repair for MR≥grade 2+, on either preoperative echocardiography or immediately after LVR, results in favorable late clinical and echocardiographic outcome that proved to be similar to patients without concomitant mitral valve repair, despite more advanced disease.
OBJECTIVE: Remodeling of the left ventricle (LV) in ischemic cardiomyopathy frequently leads to functional mitral regurgitation (MR). The indication for correcting MR in patients undergoing LV reconstruction (LVR) is unclear. In this study, we evaluated our strategy of correcting MR≥grade 2+ by restrictive mitral annuloplasty (RMA) during LVR. METHODS: We studied 92 consecutive patients (76 men, mean age 61±10 years) who underwent LVR for ischemic heart failure (IHF). RMA was performed in all patients with MR≥grade 2+ on preoperative echocardiography and in patients who showed increased MR to ≥grade 2+ immediately after LVR. Patients were attributed to a RMA and no-RMA group, depending on whether or not concomitant RMA had been performed. Mean clinical and structured echocardiographic follow-up was 47±20 months and was 100% complete. RESULTS: In 38 out of 40 patients (95%) with preoperative MR≥grade 2+, concomitant RMA was planned and performed. In 17 out of 52 patients (33%) with MR<grade 2+ preoperatively, MR increased after LVR to ≥grade 2+ leading to additional RMA during a second period of aortic cross-clamping. Early mortality in the RMA group (n=55) was 12.7% and survival at 36 months 78.2±11.2%. Early mortality in the no-RMA group (n=37) was 5.4% and survival at 36 months 81.1±12.8%. Patients in the RMA group had significantly more reduced LV function with greater LV dimensions and volumes preoperatively. Echocardiography demonstrated sustained improvement in LVEF with reduction of LV volumes in both patient groups. Recurrence of MR at late follow-up was observed in 2 patients (1 patient per group). CONCLUSIONS:Patients with IHF eligible for LV reconstruction have MR≥grade 2+ in 44% of cases. In one-third of IHF patients with MR<grade 2+ preoperatively, MR increases to ≥grade 2+ after LVR. Concomitant mitral valve repair for MR≥grade 2+, on either preoperative echocardiography or immediately after LVR, results in favorable late clinical and echocardiographic outcome that proved to be similar to patients without concomitant mitral valve repair, despite more advanced disease.
Authors: Gabriel Gregoratos; Jonathan Abrams; Andrew E Epstein; Roger A Freedman; David L Hayes; Mark A Hlatky; Richard E Kerber; Gerald V Naccarelli; Mark H Schoenfeld; Michael J Silka; Stephen L Winters; Raymond I Gibbons; Elliott M Antman; Joseph S Alpert; Loren F Hiratzka; David P Faxon; Alice K Jacobs; Valentin Fuster; Sidney C Smith Journal: J Cardiovasc Electrophysiol Date: 2002-11
Authors: Michael D Diodato; Marc R Moon; Michael K Pasque; Hendrick B Barner; Nader Moazami; Jennifer S Lawton; Marci S Bailey; Tracey J Guthrie; Bryan F Meyers; Ralph J Damiano Journal: Ann Thorac Surg Date: 2004-09 Impact factor: 4.330
Authors: Agnieszka Ciarka; Jerry Braun; Victoria Delgado; Michel Versteegh; Eric Boersma; Robert Klautz; Robert Dion; Jeroen J Bax; Nico Van de Veire Journal: Am J Cardiol Date: 2010-08-01 Impact factor: 2.778
Authors: A M Gillinov; P N Wierup; E H Blackstone; E S Bishay; D M Cosgrove; J White; B W Lytle; P M McCarthy Journal: J Thorac Cardiovasc Surg Date: 2001-12 Impact factor: 5.209
Authors: L Aklog; F Filsoufi; K Q Flores; R H Chen; L H Cohn; N S Nathan; J G Byrne; D H Adams Journal: Circulation Date: 2001-09-18 Impact factor: 29.690
Authors: Benjamin H Trichon; G Michael Felker; Linda K Shaw; Christopher H Cabell; Christopher M O'Connor Journal: Am J Cardiol Date: 2003-03-01 Impact factor: 2.778
Authors: Constantine L Athanasuleas; Gerald D Buckberg; Alfred W H Stanley; William Siler; Vincent Dor; Marisa Di Donato; Lorenzo Menicanti; Sergio Almeida de Oliveira; Friedhelm Beyersdorf; Irving L Kron; Hisayoshi Suma; Nicholas T Kouchoukos; Wistar Moore; Patrick M McCarthy; Mehmet C Oz; Francis Fontan; Meredith L Scott; Kevin A Accola Journal: J Am Coll Cardiol Date: 2004-10-06 Impact factor: 24.094
Authors: R G McKay; M A Pfeffer; R C Pasternak; J E Markis; P C Come; S Nakao; J D Alderman; J J Ferguson; R D Safian; W Grossman Journal: Circulation Date: 1986-10 Impact factor: 29.690
Authors: Yanping Cheng; Michael S Aboodi; Andrew S Wechsler; Greg L Kaluza; Juan F Granada; Kevin Van Bladel; Lon S Annest; Geng-Hua Yi Journal: Interact Cardiovasc Thorac Surg Date: 2013-08-28