Early and Late Results of Restrictive Mitral Valve Annuloplasty in 121 Patients with Cardiomyopathy and Chronic Mitral Regurgitation

Abstract

Objective: This study investigated the early and late results of restrictive mitral valve (MV) annuloplasty in patients with chronic mitral regurgitation (MR) and advanced ischemic (ICM) or dilated cardiomyopathy (DCM). Methods: From October 2001 to September 2006, 121 patients (age: 69 ± 9 years) with a left ventricular ejection fraction (LVEF) of 30 ± 9 % and chronic MR grade 3 – 4 (ICM: n = 102, DCM: n = 19) underwent restrictive prosthetic ring annuloplasty (downsizing of 2.7 ± 0.8 ring sizes). Eighty-five ICM-patients had indications for concomitant coronary artery bypass grafting (CABG). All patients were restudied at 7 ± 1 days, 3 ± 1 and 30 ± 12 months after surgery to assess survival, residual MR, New York Heart Association (NYHA) class and left ventricular (LV) function (end-systolic/end-diastolic dimensions/volume indexes and LVEF). Data were analyzed exploratively. Results: 30-day mortality was 3.3 %; survival at follow-up was 95 % and 91 %, respectively. Postoperative recurrence of significant MR (> grade 2) was absent in all patients. NYHA class, LV dimensions/volume indexes and LVEF improved significantly after surgery in both groups (p < 0.0005). A prediction of continuous postoperative improvement of myocardial function in the sense of reverse remodeling could be demonstrated by univariate logistic regression for ischemic etiology and concomitant CABG (p = 0.0001). In DCM-patients or ICM-patients without CABG, the postoperative benefit on myocardial function was limited. Conclusion: Restrictive mitral valve (MV) annuloplasty corrected chronic MR in cardiomyopathy patients with low mortality and improved contractility. Surgery also prevented recurrence of significant MR, although the phenomenon of postoperative continuous reverse myocardial remodeling could not be verified in cases with a non-ischemic etiology or ICM without concomitant CABG.

Key words

chronic mitral regurgitation - dilated cardiomyopathy - restrictive annuloplasty - reverse myocardial remodeling - downsizing - ischemic cardiomyopathy

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