Long-term outcomes of etiology specific annuloplasty ring repair of ischemic mitral regurgitation

Abstract

Background: Reductive annuloplasty repair of ischemic mitral regurgitation (IMR) is associated with high rates of recurrent MR, which may be improved with etiology-specific annuloplasty rings. Methods: From October 2005 to May 2015, 128 consecutive patients underwent repair of IMR with the GeoForm ring. Clinical data was extracted from our local Society of Thoracic Surgeons database and electronic medical records. Mortality data was obtained from the Michigan State Social Security Death Index. Results: The average age of patients was 65±11 years with mean pre-op left ventricular ejection fraction (LVEF) of 30%±10% and MR grade of 3.1±0.9 (0-4+). Thirty-day mortality was 4.7%, rate of renal failure 7.9%, rate of atrial fibrillation 27.3%, and no strokes were observed. Of the surviving patients, 89% (109/122) had a follow-up echocardiogram beyond 1 month with a mean echocardiographic followup of 59±39 months. LVEF improved from 30%±10% to 38%±14%, P<0.001) while end-diastolic (5.9±0.0 to 5.3±0.9 cm, P<0.001) and end-systolic (5.0±1.0 to 4.4±1.1 cm, P<0.001) left ventricular (LV) diameters decreased, as compared to pre-operative values. Seven patients were found to have recurrent moderate or greater IMR in follow-up to 10 years with three being due to ring dehiscence. One-, 5-, and 10-year freedom from recurrent moderate or severe IMR was 98%, 94%, and 80% respectively. One-, 5-, and 10-year survival was 91%, 77%, and 44%, respectively. Conclusions: Overall, etiology-specific ring repair of IMR was associated with low rates of recurrent MR on long-term follow-up, coupled with significant LV reverse remodeling and improvement in ejection fraction.

Prognosis for Mitral Valve Repair Surgery in Functional Mitral Regurgitation

“…In our cohort of patients with surgically repaired functional MR (of both ischemic and nonischemic etiology), we observed a recurrence of significant MR (at least grade II) in 36.9% of discharged patients after a mean follow-up of 41.8 months, data that are comparable with those of previous studies such as the 20.3% reported by Petrus et al 7) or the 32% at 3 years in ischemic MR reported by Dufendach et al 11) In recent years, the restrictive mechanism surgical technique employed for mitral repair among patients with functional MR has remained constant: restrictive annuloplasty. Studies such as that of Timek et al 19) report very low recurrence rates for repaired ischemic MR of around 6% at 5 years. Conversely, other reviews 8 – 20) calculate more variable rates of significant MR recurrence up to 55%–70% in all likelihood attributable to differences in the baseline characteristics of patients undergoing interventions and to the heterogeneity of surgical techniques employed, which makes it difficult to reach a consensus about a single strategy for the treatment of functional MR.…”

The outcome of mitral repair for degenerative versus ischemic mitral regurgitation using a single complete ring

“…17,18 No prior studies have examined the outcome of surgical mitral repair as a function of mitral disease etiology using a single repair ring. Few studies have specifically looked at intermediate-term outcomes of other specific rings, 9 and most series are collections of mixed rings. Individual series have reported recurrent moderate MR to be 10%-31% at 10 years 10 for IMR versus separate series reporting 8%-29% recurrent moderate MR at 10 years for DMR.…”

“…The current study shows that, for this population at this institution, the durability of mitral repair for IMR was better than reported in some 5,20 but not other series. [9][10][11] Despite guidelines reducing surgical repair of IMR to an IIb indication, 1 these data suggest that surgical mitral repair may have value in improving symptoms and in reducing MR to mild or less out to 10 years for selected patients with IMR. Patients appropriate for surgical IMR repair may include those with other indications for surgery or who are otherwise relatively young and low risk with relatively preserved ejection fraction and end-systolic diameter.…”

“…Several series have reported reasonably durable repair of IMR in selected patients with smaller ventricles using rigid complete undersized rings. [9][10][11] Only one study has directly compared surgical repair durability for DMR versus IMR finding similar durability at 6 years. 12 Available data regarding the durability of surgical IMR repair have little echocardiographic follow-up beyond 10 years.…”

Transcatheter Edge-to-Edge Mitral Valve Repair in Functional Mitral Regurgitation. Does it Pass Muster? Still Leaving Plenty to Be Desired

“…The second fact is that no etiology-specific designed annuloplasty rings were utilized in the trial. The GeoForm annuloplasty ring (Edwards Lifesciences, Irvine, California, USA) and IMR ETlogix ring (CMA IMR ETlogix ring®; Edwards Lifesciences, Irvine, California, USA), instead of the classic Physio annuloplasty ring (Edwards Lifesciences, Irvine, California, USA), have demonstrated a lower rate of MV regurgitation recurrence after operation in FMR [ 29 , 30 ] .…”