Koji Furukawa1,2, Mitsuhiro Yano3, Eisaku Nakamura4, Masanori Nishimura3, Kunihide Nakamura4. 1. Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Japan. koji_furukawa@med.miyazaki-u.ac.jp. 2. Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki City, Miyazaki, 889-1692, Japan. koji_furukawa@med.miyazaki-u.ac.jp. 3. Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Japan. 4. Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki City, Miyazaki, 889-1692, Japan.
Abstract
OBJECTIVES: Mitral annuloplasty (MAP) for ischemic mitral regurgitation (IMR) with advanced remodeling is often associated with recurrent mitral regurgitation (MR). We performed surgeries adjusted according to the degree of remodeling; i.e., for advanced remodeling cases, we added subvalvular repair (SVR) to MAP. This study aimed to evaluate our experience with patients with IMR. METHODS AND RESULTS: Thirty patients with IMR (MR grade ≥ 2) were retrospectively analyzed. We performed MAP with SVR for 13 patients (MAP + SVR group) and MAP alone for 17 patients (MAP group). The MAP + SVR group had significantly larger left ventricular dimension and tenting height than the MAP group. Four patients (two in each group) experienced recurrence of MR (MR grade ≥ 2), and the 3-year and 5-year freedom from recurrence of MR rates were 97% and 83%, respectively. Six patients (two in the MAP group and four in the MAP + SVR group) died of cardiac causes during follow-up, and the 3-year and 5-year freedom from cardiac-related death rates were 81% and 74%, respectively. There was no difference between the 2 groups regarding freedom from recurrent MR (p = 0.6) and freedom from cardiac-related death (p = 0.1). The preoperative left ventricular end-systolic dimension was a significant predictor of cardiac death in the multivariate analysis. CONCLUSION: Mitral valve repair adjusted according to the degree of remodeling progression provided durable mitral competence; however, it remains unclear if such a strategy is related to a high probability of freedom from cardiac-related death.
OBJECTIVES:Mitral annuloplasty (MAP) for ischemic mitral regurgitation (IMR) with advanced remodeling is often associated with recurrent mitral regurgitation (MR). We performed surgeries adjusted according to the degree of remodeling; i.e., for advanced remodeling cases, we added subvalvular repair (SVR) to MAP. This study aimed to evaluate our experience with patients with IMR. METHODS AND RESULTS: Thirty patients with IMR (MR grade ≥ 2) were retrospectively analyzed. We performed MAP with SVR for 13 patients (MAP + SVR group) and MAP alone for 17 patients (MAP group). The MAP + SVR group had significantly larger left ventricular dimension and tenting height than the MAP group. Four patients (two in each group) experienced recurrence of MR (MR grade ≥ 2), and the 3-year and 5-year freedom from recurrence of MR rates were 97% and 83%, respectively. Six patients (two in the MAP group and four in the MAP + SVR group) died of cardiac causes during follow-up, and the 3-year and 5-year freedom from cardiac-related death rates were 81% and 74%, respectively. There was no difference between the 2 groups regarding freedom from recurrent MR (p = 0.6) and freedom from cardiac-related death (p = 0.1). The preoperative left ventricular end-systolic dimension was a significant predictor of cardiac death in the multivariate analysis. CONCLUSION:Mitral valve repair adjusted according to the degree of remodeling progression provided durable mitral competence; however, it remains unclear if such a strategy is related to a high probability of freedom from cardiac-related death.
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