Document Detail


Mitral annuloplasty with IMR ETlogix ring for ischemic mitral regurgitation and left ventricular dysfunction.
MedLine Citation:
PMID:  23167218     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
BACKGROUND AND AIM OF THE STUDY: Chronic ischemic mitral regurgitation (IMR) is associated with asymmetric mitral leaflet tethering and annular dilation. The Carpentier-McCarthy-Adams IMR ETlogix annuloplasty ring is designed specifically to treat these asymmetric pathological changes. In the present study, the results of mitral annuloplasty with this ring in a selected subset of patients with significant IMR and left ventricular (LV) dysfunction were analyzed.
METHODS: Between May 2005 and September 2009, the IMR ETlogix ring was implanted in 140 consecutive patients with grade > OR = 2+ IMR (graded from 0 to 3+). Of these patients, 41 (29%) suffered from preoperative LV dysfunction (defined as LV ejection fraction < OR = 0.35). Ten of these 41 patients underwent combined aortic valve replacement or LV restoration, and thus were excluded from this retrospective study; consequently, 31 patients (mean age 67.1 +/- 7.7 years) were enrolled into the study. Preoperatively, 18 patients (58%) were in NYHA class III or IV, and 16 (52%) were in CCS class 3 or 4. The expected operative risk according to the logistic EuroSCORE was 22.4 +/- 16.5%. Using two-dimensional echocardiography, postoperative changes in the mitral annular diameter (MAD), tethering area (TA), and tenting height (TH) of the mitral valve in four-chamber, two-chamber, and long-axis views, were assessed at mid-systole.
RESULTS: All patients underwent complete myocardial revascularization. One (3%) in-hospital (non-cardiac) death occurred. During a mean follow up of 3.4 +/- 1.5 years (range: 0.2 to 5.9 years), one early mitral replacement was required (due to endocarditis), and there were two cardiac deaths and three non-cardiac deaths. The four-year actuarial survival and freedom from heart failure hospital readmission were 82% and 75%, respectively. Heart failure symptoms were improved (p = 0.001), and IMR was well controlled within grade 1+ (p < 0.0001) for the 24 remaining patients. The MAD, TA and TH were each decreased in all three echocardiographic views (p < OR = 0.0006). The MAD reduction was greater in the long-axis view than in the four-chamber (56% versus 49%, p = 0.002) and two-chamber (56% versus 43%, p = 0.0003) views.
CONCLUSION: In selected patients with chronic ischemic LV dysfunction, mitral annuloplasty with the IMR ETlogix ring, combined with complete myocardial revascularization, restored the mitral apparatus geometry and competence.
Authors:
Giuseppe Gatti; Bruno Pinamonti; Luca Dellangela; Francesco Antonini-Canterin; Bernardo Benussi; Gianfranco Sinagra; Aniello Pappalardo
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  21     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-11-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  556-63     Citation Subset:  IM    
Affiliation:
Divisions of Cardiac Surgery, AOU Ospedali Riuniti, Trieste, Italy. gius.gatti@gmail.com
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