| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Eur J Cardiothorac Surg 2005;27:847-853
© 2005 Elsevier Science NL
a Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 1, 2333 AL Leiden, The Netherlands
b Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
c Department of Epidemiology and Statistics, Erasmus University, Rotterdam, The Netherlands
Received 21 September 2004; received in revised form 16 December 2004; accepted 23 December 2004.
* Corresponding author. Tel.: +31 71 526 4022; fax: +31 71 524 8284. (E-mail: r.a.e.dion{at}lumc.nl).
Objective: Ischemic mitral regurgitation can be treated with a restrictive mitral annuloplasty, with or without coronary revascularization. In this study, the extent of reverse remodeling of the left ventricle following this strategy is assessed, as well as the factors that influence it. Methods: Eighty-seven consecutive patients with ischemic mitral regurgitation and a mean ejection fraction of 32±10% underwent restrictive mitral annuloplasty (downsizing by two ring sizes, median ring size 26), with additional coronary revascularization in 75 patients. All underwent transthoracic echocardiography 18 months after surgery to assess residual mitral regurgitation, mitral valve gradient and left ventricular end-systolic and end-diastolic dimensions. Univariate and multivariate analysis was performed to identify predictors for reverse remodeling, defined as a 10% reduction in left ventricular dimension. Receiver-operating characteristic analysis was used to identify cut-off values for preoperative left ventricular dimensions in predicting reverse remodeling. Results: Early mortality was 8.0% (seven patients, three non-cardiac), late mortality was 7.5% (six patients, four non-cardiac). There were two reoperations (redo annuloplasty), and four readmissions for heart failure. At 29 months follow-up, NYHA class improved from 3.0±0.9 to 1.3±0.5 (P<0.01). Mitral regurgitation grade decreased from 3.1±0.5 to 0.6±0.6 at 18 months, left ventricular end-systolic dimension decreased from 52±8 to 44±11 mm (P<0.01), and end-diastolic dimension from 64±8 to 58±10mm (P<0.01). Multivariate analysis identified preoperative left ventricular end-diastolic dimension as the single best factor in predicting occurrence of reverse remodeling. For end-systolic dimension, 51mm was the optimal cut-off value to predict reverse remodeling (specificity and sensitivity 81%, area under curve 0.85); for end-diastolic dimension, the cut-off value was 65mm (specificity and sensitivity 89%, area under curve 0.92). Conclusions: Stringent restrictive mitral annuloplasty with or without revascularization provides excellent clinical results with acceptable mortality. At 18 months follow-up, there is no significant residual mitral regurgitation. Reverse remodeling occurs in the majority of patients, but is limited by preoperative left ventricular dimensions. In patients with a left ventricular end-diastolic dimension exceeding 65mm, additional surgical procedures are necessary to try and obtain reverse remodeling in this subgroup.
Key Words: Ischemic mitral regurgitation • Restrictive annuloplasty • Ischemic cardiomyopathy • Heart failure • Coronary artery bypass grafting
This article has been cited by other articles:
|
|
 |
|
  S. Gelsomino, R. Lorusso, C. Rostagno, S. Caciolli, G. Bille, G. De Cicco, S. Romagnoli, C. Porciani, P. Stefano, and G. F. Gensini Prognostic value of Doppler-derived mitral deceleration time on left ventricular reverse remodelling after undersized mitral annuloplasty Eur J Echocardiogr, September 1, 2008; 9(5): 631 - 640. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Gelsomino, R. Lorusso, S. Caciolli, I. Capecchi, C. Rostagno, M. Chioccioli, G. De Cicco, G. Bille, P. Stefano, and G. F. Gensini Insights on left ventricular and valvular mechanisms of recurrent ischemic mitral regurgitation after restrictive annuloplasty and coronary artery bypass grafting. J. Thorac. Cardiovasc. Surg., August 1, 2008; 136(2): 507 - 518. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. A. Carabello The Current Therapy for Mitral Regurgitation J. Am. Coll. Cardiol., July 29, 2008; 52(5): 319 - 326. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. D. Crabtree, M. S. Bailey, M. R. Moon, N. Munfakh, M. K. Pasque, J. S. Lawton, N. Moazami, K. A. Aubuchon, A. S. Al-Dadah, and R. J. Damiano Jr Recurrent mitral regurgitation and risk factors for early and late mortality after mitral valve repair for functional ischemic mitral regurgitation. Ann. Thorac. Surg., May 1, 2008; 85(5): 1537 - 1542. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Gelsomino, R. Lorusso, I. Capecchi, C. Rostagno, S. Romagnoli, G. Bille, G. De Cicco, C. Tetta, P. Stefano, and G. F. Gensini Left Ventricular Reverse Remodeling After Undersized Mitral Ring Annuloplasty in Patients With Ischemic Regurgitation Ann. Thorac. Surg., April 1, 2008; 85(4): 1319 - 1330. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A.E. Dion Invited Commentary Ann. Thorac. Surg., April 1, 2008; 85(4): 1330 - 1331. [Full Text] [PDF]
|
|
|
|
|
|
K. Takeda, G. Matsumiya, H. Matsue, M. Sakaki, T. Sakaguchi, T. Fujita, and Y. Sawa Left Ventricular Reconstructive Surgery in Ischemic Dilated Cardiomyopathy Complicated With Cardiogenic Shock Ann. Thorac. Surg., April 1, 2008; 85(4): 1339 - 1343. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Agricola, M. Oppizzi, M. Pisani, A. Meris, F. Maisano, and A. Margonato Ischemic mitral regurgitation: mechanisms and echocardiographic classification Eur J Echocardiogr, March 1, 2008; 9(2): 207 - 221. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Braun, N. R. van de Veire, R. J.M. Klautz, M. I.M. Versteegh, E. R. Holman, J. J.M. Westenberg, E. Boersma, E. E. van der Wall, J. J. Bax, and R. A.E. Dion Restrictive Mitral Annuloplasty Cures Ischemic Mitral Regurgitation and Heart Failure Ann. Thorac. Surg., February 1, 2008; 85(2): 430 - 437. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Gelsomino, R. Lorusso, G. De Cicco, I. Capecchi, C. Rostagno, S. Caciolli, S. Romagnoli, U. Da Broi, P. Stefano, and G. F. Gensini Five-year echocardiographic results of combined undersized mitral ring annuloplasty and coronary artery bypass grafting for chronic ischaemic mitral regurgitation Eur. Heart J., January 2, 2008; 29(2): 231 - 240. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Kolh Surgical correction of ischaemic mitral regurgitation still a long way to go Eur. Heart J., January 2, 2008; 29(2): 147 - 149. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Enriquez-Sarano, V. T. Nkomo, and H. Michelena Principles and Practice of Echocardiography in Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 315 - 348. [Full Text]
|
|
|
|
|
|
W. Y. Szeto, R. C. Gorman, J. H. Gorman III, and M. A. Acker Ischemic Mitral Regurgitation Card. Surg. Adult, January 1, 2008; 3(2008): 785 - 802. [Full Text]
|
|
|
|
|
|
J. I. Fann, N. B. Ingels Jr., and D. C. Miller Pathophysiology of Mitral Valve Disease Card. Surg. Adult, January 1, 2008; 3(2008): 973 - 1012. [Full Text]
|
|
|
|
 |
|
 V. M. Shipulin, V. A. Kazakov, I. V. Suhodolo, E. V. Krivoshekov, A. A. Lezhnev, B. N. Kozlov, V. Ch. Vaizov, and A. A. Miller Causes of repeated remodeling of left ventricle after Dor procedure Interactive CardioVascular and Thoracic Surgery, December 1, 2007; 6(6): 772 - 777. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Roshanali, M. H. Mandegar, M. A. Yousefnia, H. Rayatzadeh, and F. Alaeddini A Prospective Study of Predicting Factors in Ischemic Mitral Regurgitation Recurrence After Ring Annuloplasty Ann. Thorac. Surg., September 1, 2007; 84(3): 745 - 749. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Borger, P. M. Murphy, A. Alam, S. Fazel, M. Maganti, S. Armstrong, V. Rao, and T. E. David Initial results of the chordal-cutting operation for ischemic mitral regurgitation J. Thorac. Cardiovasc. Surg., June 1, 2007; 133(6): 1483 - 1492. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Authors/Task Force Members, A. Vahanian, H. Baumgartner, J. Bax, E. Butchart, R. Dion, G. Filippatos, F. Flachskampf, R. Hall, B. Iung, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology Eur. Heart J., January 26, 2007; (2007) ehl428v1. [Full Text] [PDF]
|
|
|
|
|
|
H. Suma, T. Isomura, T. Horii, and F. Nomura Septal anterior ventricular exclusion procedure for idiopathic dilated cardiomyopathy. Ann. Thorac. Surg., October 1, 2006; 82(4): 1344 - 1348. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Horii, H. Suma, T. Isomura, F. Nomura, and J. Hoshino Left ventricle volume affects the result of mitral valve surgery for idiopathic dilated cardiomyopathy to treat congestive heart failure. Ann. Thorac. Surg., October 1, 2006; 82(4): 1349 - 1355. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J J Bax and D Poldermans Mitral regurgitation and left ventricular dyssynchrony: implications for treatment Heart, October 1, 2006; 92(10): 1363 - 1364. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Langer, F. Rodriguez, A. Cheng, S. Ortiz, T. C. Nguyen, M. K. Zasio, D. Liang, G. T. Daughters, N. B. Ingels, and D. C. Miller Posterior mitral leaflet extension: An adjunctive repair option for ischemic mitral regurgitation? J. Thorac. Cardiovasc. Surg., April 1, 2006; 131(4): 868 - 877. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. D. Koch, E. R. Holman, M. I.M. Versteegh, R. J.M. Klautz, S. T. Somer, J. J. Bax, and R. A.E. Dion Reconstruction of the Left Ventricle After Previous Aneurysmectomy Ann. Thorac. Surg., April 1, 2006; 81(4): 1495 - 1497. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Nomura, T. Isomura, T. Horii, H. Irie, J. Hoshino, H. Makinae, and H. Suma Efficacy of left ventricular restoration with mitral valve surgery for endstage ischemic cardiomyopathy Interactive CardioVascular and Thoracic Surgery, April 1, 2006; 5(2): 179 - 182. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. De Simone, I. Wolf, S. Mottl-Link, R. Hoda, B. Mikhail, F.-U. Sack, H.-P. Meinzer, and S. Hagl A clinical study of annular geometry and dynamics in patients with ischemic mitral regurgitation: new insights into asymmetrical ring annuloplasty Eur. J. Cardiothorac. Surg., March 1, 2006; 29(3): 355 - 361. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
