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Mid-term echocardiographic results with different rings following restrictive mitral annuloplasty for ischaemic cardiomiopathy

^a Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
^b Cardiology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy

Received 26 August 2008; received in revised form 26 February 2009; accepted 3 March 2009.

^_* Corresponding author. Address: Viale dei Pini, 28, 80131 Napoli, Italy. Tel.: +39 081 7441531; fax: +39 0961 712405. (Email: frankono{at}libero.it).

Background: Despite restrictive mitral annuloplasty (RMA) being considered effective for chronic ischaemic mitral regurgitation (CIMR), few data exist on mid-term echocardiographic results with different prosthetic rings. Therefore, comparative echocardiographic analysis has been performed. Methods: Sixty-four consecutive coronary artery bypass graft surgery (CABG) + RMA (downsizing by two-ring sizes; median size: 26 mm) for CIMR with a follow-up of at least 6 months were prospectively followed-up with serial echocardiograms (preoperative, discharge, 6 months, follow-up ending). Hospital mortality, follow-up clinical and echocardiographic results were analysed and compared between three groups (group A: semi-rigid band, 17 patients; group B: complete symmetric semi-rigid, 22 patients; group C: complete asymmetric semi-rigid, 25 patients). Results: Hospital mortality was 6.3%; 22.8 ± 14.7 standard deviation (SD) months (range: 6–55) survival was 96.5 ± 2.5%; freedom from re-intervention was 94.2 ± 4.2%, from re-revascularisation 87.5 ± 11.7%, from grade-2 mitral regurgitation 58.2 ± 9.8% and from heart failure (CHF) 71.6 ± 10.5%. Recurrent (grade-2) CIMR resulted in lower freedom-from-CHF (p = 0.0001), worsened New York Heart Association (NYHA) classification (p = 0.0001) and absence of reverse remodelling of the left ventricular end-diastolic diameter (LVEDD; p = 0.004), systolic diameter (LVESD; p = 0.014), indexed mass (LVMi; p = 0.005) and coaptation depth (p = 0.0001). Group A showed significant worse freedom from CHF (group A: 42.8 ± 19.5% vs group B: 88.9 ± 10.5% vs group C: 92.3 ± 7.5%; p = 0.049) and from recurrent CIMR (17.4 ± 13.8% vs 82.1 ± 11.7% vs 94.1 ± 5.7%, respectively; p = 0.0001). Complete rings decreased the hazard of recurrent CIMR (Physio = 0.141; Adams = 0.089). Higher NYHA during follow-up was found in group A (p = 0.002 for group B and p = 0.001 for group C) with a progressive reduction of trans-mitral mean gradient (p = 0.001), and a lower degree of reverse remodelling of LVEDD (p = 0.009 and p = 0.010) and coaptation depth (p = 0.040 and p = 0.002). Conclusions: Recurrent CIMR correlates with absent ventricular reverse remodelling. Despite a higher trans-mitral gradient, complete rings achieve better results in the treatment of CIMR.

Key Words: Restrictive annuloplasty • Mitral rings • Ischaemic mitral regurgitation • Coaptation depth • Reverse remodelling