Mitral Valve Reconstruction in Elderly, Ischemic Patients

Bolling, Steven F.; Deeb, G. Michael; Bach, David S.

doi:10.1378/chest.109.1.35

Cited by 67 publications

(43 citation statements)

References 25 publications

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“…Nonetheless, after encouraging initial results, 25 different studies have revealed a significant proportion of patients developing recurrent MR during follow-up 4,7,26 which has been mainly related to continued LV remodelling and persistent leaflet tethering. 5,27 We reported our experience with this technique.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…En la década de1980-89 se observó un aumento de la enfermedad degenerativa y fueron estos pacientes en los que los procedimientos reconstructores tuvieron su mayor aplicación. En la década de 1990-99, los beneficios de la RpVM se establecieron sólidamente para estos, por lo que la atención se dirigió ahora a la IM isquémica, desarrollándose conceptos y procedimientos quirúrgicos específicos para esta 14,[19][20][21][22] .…”

Section: Discussionunclassified

Veinte años de cirugía reparadora de la válvula mitral

S¹,

S²,

Z³

et al. 2014

Rev. méd. Chile

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“…Teniendo como base esta anatomía y esta fi siopatología, es que surge como tratamiento quirúrgico de la insufi ciencia mitral isquémica ventricular la "anuloplastía mitral", la que pretende reducir el anillo mitral de manera de aumentar la coaptación de los velos y la que no tendría, además, el efecto deleterio propio del reemplazo mitral, en un ventrículo izquierdo ya dañado por la enfermedad coronaria [15][16][17][18][19][20] .…”

Section: Discussionunclassified

“…Igualmente, se acepta que debe efectuarse una "sobre-reducción" del anillo mitral nativo, utilizando anillos protésicos uno o dos números inferiores al medido con el probador correspondiente 17,18,23 .…”

Section: Discussionunclassified

“…En la actualidad, el tratamiento de elección de la insufi ciencia mitral isquémica ventricular es la anuloplastía mitral con anillo protésico rígido o semi-rígido, junto a la revascularización miocár-dica quirúrgica 2,3,[15][16][17][18][19][20] . Es esta estrategia terapéutica la que hemos progresivamente privilegiado, por sobre el reemplazo mitral, desde 1992 en nuestra institución, y cuyo resultados alejados, en cuanto a sobrevida, seguimiento ecocardiográfi co y reoperación, son el motivo de esta comunicación.…”

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Resultados alejados de la cirugía reparadora de la insuficiencia mitral isquémica

et al. 2011

Rev. méd. Chile

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Mitral Valve Reconstruction in Elderly, Ischemic Patients

Cited by 67 publications

References 25 publications

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

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

Veinte años de cirugía reparadora de la válvula mitral

Resultados alejados de la cirugía reparadora de la insuficiencia mitral isquémica

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