Document Detail


Flexible versus nonflexible mitral valve rings for congestive heart failure: differential durability of repair.
MedLine Citation:
PMID:  16820648     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Surgical intervention is playing an increasingly important therapeutic role in congestive heart failure (CHF) patients with ischemia and dilated cardiomyopathy. Their mitral regurgitation (MR) is a result of left ventricular (LV) geometrical distortion. The optimal type of ring for CHF patients with geometric ventricular-based MR is unknown. This study reviewed the results of flexible versus nonflexible complete mitral valve rings in CHF patients with geometric mitral regurgitation. METHODS AND RESULTS: Using a prospectively maintained database, patients undergoing mitral valve reconstruction (MVR) with either a flexible or nonflexible complete ring were identified on the basis of preoperative ejection fraction (EF) < or = 30% and no primary mitral pathology. These 2 groups of CHF patients with severe geometric MR were then compared in terms of recurrent MR requiring reoperation. Between 1992 and 2004, 289 patients with EF < or = 30%, received an undersized complete mitral annuloplasty ring as their MVR procedure. Of these, 170 patients had a flexible complete ring. In follow-up, 16 "flexible" patients (9.4%) required a repeat procedure for significant recurrent geometric MR and CHF (10 replacements, 3 re-repairs, 3 transplants). The average time to reoperation was 2.4 years. In contrast, 119 patients with an EF < or = 30% received a MVR using an undersized nonflexible complete ring. Only 3 "non-flexible" patients required a repeat operation, MVR (1), and 2 patients required a transplant. The time to reoperation was 4.0 years. A significant difference in reoperation rates, for recurrent MR, between the 2 groups (P=0.012). There were no differences between groups, in terms of age, ring size used, preoperative EF, LV size, MR grade, or New York Heart Association class. CONCLUSIONS: Patients with CHF having a flexible ring have a higher likelihood of developing recurrent MR requiring reoperation. The use of a nonflexible ring appears to significantly reduce the need for repeat surgical procedures. Further refinement and development of nonflexible ring systems, aimed at LV restoration, deserve ongoing investigation.
Authors:
Martinus T Spoor; Amy Geltz; Steven F Bolling
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  Circulation     Volume:  114     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-07-05     Completed Date:  2006-08-18     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  I67-71     Citation Subset:  AIM; IM    
Affiliation:
Section of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan 48109-0348, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Aspirin / therapeutic use
Cardiomyopathy, Dilated / complications*,  pathology
Combined Modality Therapy
Databases, Factual
Digoxin / therapeutic use
Diuretics / therapeutic use
Drug Therapy, Combination
Equipment Design
Female
Follow-Up Studies
Heart Failure / drug therapy,  etiology,  pathology,  surgery*,  ultrasonography
Heart Ventricles / pathology*
Heart-Assist Devices
Humans
Male
Middle Aged
Milrinone / therapeutic use
Mitral Valve / surgery*
Mitral Valve Insufficiency / etiology,  surgery*
Norepinephrine / therapeutic use
Pliability
Postoperative Complications / epidemiology
Prospective Studies
Recurrence
Reoperation
Spironolactone / therapeutic use
Stroke Volume
Time Factors
Tricuspid Valve Insufficiency / complications,  surgery
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Diuretics; 20830-75-5/Digoxin; 50-78-2/Aspirin; 51-41-2/Norepinephrine; 52-01-7/Spironolactone; 78415-72-2/Milrinone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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