Document Detail


Restrictive annuloplasty and coronary revascularization in ischemic mitral regurgitation results in reverse left ventricular remodeling.
MedLine Citation:
PMID:  15364847     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Data on combined coronary artery bypass grafting (CABG) and restrictive annuloplasty in patients with ischemic cardiomyopathy are scarce, and the effect on reverse left ventricular (LV) remodeling is unknown. METHODS AND RESULTS: 51 patients with ischemic LV dysfunction (LV ejection fraction 31+/-8%) and severe mitral regurgitation (grade 3 to 4+) underwent CABG and restrictive annuloplasty with stringent downsizing of the mitral annulus (by 2 sizes, Physio-ring, mean size 28+/-2). Serial transthoracic echocardiographic studies were performed (before surgery and within 3 months and 1.5 years after surgery) to assess mitral regurgitation, transmitral gradient, leaflet coaptation, and left atrial and LV reverse remodeling. Clinical follow-up (New York Heart Association [NYHA] class, survival, events) was assessed at 2-year follow-up. Early operative mortality was 5.6%; at 2-year follow-up, all patients were free of endocarditis and thromboembolism, and 1 needed re-operation for recurrent mitral regurgitation; 2-year survival was 84%. NYHA class improved from 3.4+/-0.8 to 1.3+/-0.4 (P<0.01), with all patients in class I/II. Intraoperative transesophageal echo showed minimal (grade 1+) mitral regurgitation in 8 patients and none in 43, without stenosis. Leaflet coaptation was 0.8+/-0.2 cm. These values remained unchanged; all patients had no or minimal (grade 1+) mitral regurgitation at 2-year follow-up. LV end-systolic and end-diastolic dimensions decreased from 51+/-10 to 43+/-12 mm (P<0.001) and from 64+/-8 to 58+/-11 mm (P<0.001). Left atrial dimension decreased from 53+/-8 to 47+/-7 mm (P<0.001). CONCLUSIONS: Excellent results of combined restrictive annuloplasty and CABG were obtained. Residual mitral regurgitation was absent/minimal at 2-year follow-up, associated with a significant reduction in left atrial dimension and LV reverse remodeling.
Authors:
Jeroen J Bax; Jerry Braun; Soeresh T Somer; Robert Klautz; Eduard R Holman; Michel I M Versteegh; Eric Boersma; Martin J Schalij; Ernst E van der Wall; Robert A Dion
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  110     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-09-14     Completed Date:  2005-04-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  II103-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. jbax@knoware.nl
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Coronary Artery Bypass*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Mitral Valve Insufficiency / etiology,  surgery*,  ultrasonography
Myocardial Ischemia / complications,  surgery*
Postoperative Complications
Stroke Volume
Treatment Outcome
Ventricular Remodeling*

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


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