Downsizing of the mitral valve and coronary revascularization in severe ischemic mitral regurgitation results in reverse left ventricular and left atrial remodeling

Geidel, Stephan; Laß, Michael; Schneider, Carsten; Groth, G.; Boczor, Sigrid; Kuck, Karl‐Heinz; Ostermeyer, J.

doi:10.1016/j.ejcts.2005.02.025

Cited by 63 publications

(35 citation statements)

References 28 publications

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“…Hence, annuloplasty successfully reduces MR grade in most patients having surgery for IMR. Furthermore, recent reports document that stringent use of a rigid or semi-rigid, complete annuloplasty ring appears to provide excellent (up to 2 years) freedom from recurrent MR [34][35][36]. It is possible that application of this approach, combined with patient selection based upon identifiable and measurable indices on preoperative echocardiography, will enhance durability of annuloplasty for functional IMR.…”

Section: Durabilitymentioning

confidence: 93%

Is ischemic mitral regurgitation an indication for surgical repair or replacement?

Gillinov

2006

Heart Fail Rev

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Ischemic mitral regurgitation (IMR) is common in patients with coronary artery disease. While it is well-known that IMR exerts a graded effect upon survival-the greater the degree of IMR, the lower the survival-the indications for surgical treatment and the choice of surgical procedure (repair versus replacement) are controversial. In patients with mild to moderate IMR, the benefit of a mitral valve procedure has not been demonstrated, and surgical practice varies. In patients with severe IMR, mitral valve surgery is the norm, but guidelines for choosing between valve repair and valve replacement do not exist. Furthermore, the survival impact of mitral valve surgery in patients with severe IMR is uncertain. When patients with severe IMR undergo mitral valve surgery, undersized annuloplasty results in durable repair in 70% to 85% of cases. Newly-developed adjunctive repair techniques may further improve results. Currently, mitral valve repair is the procedure of choice in the majority of patients having surgery for severe IMR. However, the most severely ill patients and those with certain echocardiographic characteristics (e.g. severe bileaflet tethering) should be treated with bioprosthetic mitral valve replacement rather than repair.

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Section: Durabilitymentioning

confidence: 93%

Is ischemic mitral regurgitation an indication for surgical repair or replacement?

Gillinov

2006

Heart Fail Rev

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“…The anterior leaflet tethering significantly improved and remained stable in these patients, confirming that it is the augmented and, more important, progressive posterior leaflet tethering that is related to recurrent mitral regurgitation after annuloplasty. On the other hand, coronary bypass grafting and stringent downsizing of the mitral annulus by Physio rings 2 sizes smaller than measured have had promising results 7,8 with excellent competence of the mitral valve at the 2-year follow-up. This aggressive approach also provided for reverse remodeling of the left ventricle, which, presumably, is key to the long-term success of this approach.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] The conventional surgical treatment of severe mitral regurgitation in the absence of morphological abnormalities of the valve has been remodeling annuloplasty because coronary artery bypass grafting alone has led to a very high incidence of postoperative residual mitral regurgitation. 6 Unfortunately, although some investigators have reported good results, particularly with aggressive undersized annuloplasty, 7,8 other groups have experienced very high rates of recurrence of moderate or severe mitral regurgitation after such repairs. 9 -12 …”

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confidence: 99%

Initial Results of Posterior Leaflet Extension for Severe Type IIIb Ischemic Mitral Regurgitation

et al. 2009

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Background-Management of severe ischemic mitral regurgitation remains difficult with disappointing early and intermediate-term surgical results of valve repair. Methods and Results-Forty-four patients with severe (4ϩ) Carpentier type IIIb ischemic mitral regurgitation underwent mitral valve repair, with or without surgical revascularization, by posterior leaflet extension with a patch of bovine pericardium and a remodeling annuloplasty. Serial echocardiography was performed preoperatively, intraoperatively, and postoperatively to assess mitral valve competence. The postoperative functional status of patients was assessed. The average Parsonnet score was 38Ϯ13. Thirty-day mortality was 11%, and late mortality was 14%. Mean follow-up was 38 months. The actuarial freedom from moderate or severe recurrent mitral regurgitation was 90% at 2 years, whereas 90% of patients were in New York Heart Association class I at 2 years. Conclusion-Posterior

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“…In contrast with these results, Braun and coworkers 4 reported that, in 87 patients undergoing restrictive ring annuloplasty (2 ring sizes, median ring size 26), no patient showing MR 3 and 2 with MR graded 2þ at 18-month follow-up. In addition, Geidel et al 28 …”

Section: Recurrence Of Mitral Regurgitationmentioning

confidence: 99%

Five-year echocardiographic results of combined undersized mitral ring annuloplasty and coronary artery bypass grafting for chronic ischaemic mitral regurgitation

Gelsomino

Lorusso²,

Cicco³

et al. 2007

European Heart Journal

117

102

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AimsWe present 5-year echocardiographic results of combined undersizing mitral ring annuloplasty (UMRA) and coronary artery bypass grafting (CABG) in chronic ischaemic mitral regurgitation (CIMR). Methods and resultsTwo hundred and fifty-one patients (aged 68.4 + 8.1, 62.5% male) undergoing combined CABG and UMRA in our Institution (Cardiac Surgery, Careggi Hospital, Florence, Italy) between September 2001 and March 2007 were prospectively enrolled in the study. Median follow up was 32.9 months [interquartile range (IQR) 17.5-51.6]. Fourteen patients with significant residual mitral regurgitation (MR) needing immediate intraoperative revision (n ¼ 3) or at discharge (n ¼ 11) were excluded from the study. Serial echocardiograms were performed in 220 survivors at baseline, discharge, and annually thereafter. Additionally, 17 patients died (2 early and 15 late deaths) and were also excluded from the study. MR remained stable at 1 year and re-increased at 3 years (P , 0.001) and 5 years (P , 0.001). Fiveyear actuarial survival was 83.2 + 4.4. Five-year freedom from re-operation for failed repair was 78.2 + 4.9%. Mean systolic and diastolic diameters decreased significantly at discharge (P ¼ 0.001 and P ¼ 0.01, respectively) and at early follow up (P ¼ 0.004 and P ¼ 0.02) but raised at 3 years (P , 0.001) and 5 years (P , 0.001). Systolic and diastolic sphericity indexes improved at discharge (P , 0.001) remained stable at 1 year but they re-increased at 3-year control (P ¼ 0.006 and P ¼ 0.03, respectively) with a late raise exceeding the pre-operative value (P , 0.001). Left ventricular reverse remodelling was observed in 44.2% of the study population with 10.3% of patients showing further left ventricular dilatation. At multivariable model, end-systolic volume 145 mL, systolic sphericity index 0.7, myocardial performance index 0.9, and wall motion score index 1.5 were predictors of recurrent MR. ConclusionOur findings emphasize the need for improved repair technique and better patient selection to identify patients with anticipated repair failure who could benefit more from valve replacement or other procedure directly addressing ventricular tethering.--

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Downsizing of the mitral valve and coronary revascularization in severe ischemic mitral regurgitation results in reverse left ventricular and left atrial remodeling

Abstract: Combined mitral downsizing and CABG surgery was performed with excellent clinical results: only minimal residual MR, a significant reduction of LA dimension and an increase of LV contractility due to reverse remodeling were observed.

Cited by 63 publications

References 28 publications

Is ischemic mitral regurgitation an indication for surgical repair or replacement?

Is ischemic mitral regurgitation an indication for surgical repair or replacement?

Initial Results of Posterior Leaflet Extension for Severe Type IIIb Ischemic Mitral Regurgitation

Five-year echocardiographic results of combined undersized mitral ring annuloplasty and coronary artery bypass grafting for chronic ischaemic mitral regurgitation

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