Long-term outcomes of etiology specific annuloplasty ring repair of ischemic mitral regurgitation.
Mitral valve repair
annuloplasty
ischemic mitral regurgitation (IMR)
Journal
Annals of cardiothoracic surgery
ISSN: 2225-319X
Titre abrégé: Ann Cardiothorac Surg
Pays: China
ID NLM: 101605877
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
entrez:
12
2
2021
pubmed:
13
2
2021
medline:
13
2
2021
Statut:
ppublish
Résumé
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. 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. 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 follow-up 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. 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.
Sections du résumé
BACKGROUND
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
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
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 follow-up 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
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.
Identifiants
pubmed: 33575184
doi: 10.21037/acs-2020-mv-fs-0166
pii: acs-10-01-141
pmc: PMC7867429
doi:
Types de publication
Journal Article
Langues
eng
Pagination
141-148Informations de copyright
2021 Annals of Cardiothoracic Surgery. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of Interest: The authors have no conflicts of interest to declare.
Références
N Engl J Med. 2016 Jan 28;374(4):344-53
pubmed: 26550689
J Am Coll Cardiol. 2007 Jun 5;49(22):2191-201
pubmed: 17543639
J Thorac Cardiovasc Surg. 2019 Oct;158(4):1058-1068
pubmed: 30803776
Eur J Echocardiogr. 2009 Jan;10(1):74-81
pubmed: 18490271
Int J Cardiol. 2016 Nov 1;222:924-930
pubmed: 27526360
Am J Cardiol. 2015 Sep 15;116(6):913-8
pubmed: 26170249
J Thorac Cardiovasc Surg. 2014 Nov;148(5):1951-6
pubmed: 24685379
ASAIO J. 2010 Nov-Dec;56(6):491-6
pubmed: 21042057
J Heart Valve Dis. 2014 Nov;23(6):695-706
pubmed: 25790616
PLoS One. 2018 Jun 14;13(6):e0198331
pubmed: 29902273
N Engl J Med. 2016 May 19;374(20):1932-41
pubmed: 27040451
J Thorac Cardiovasc Surg. 2011 Feb;141(2):345-53
pubmed: 21241857
Circulation. 2006 Jul 4;114(1 Suppl):I588-93
pubmed: 16820643
Eur J Cardiothorac Surg. 2011 Aug;40(2):488-95
pubmed: 21232967
N Engl J Med. 2014 Jan 2;370(1):23-32
pubmed: 24245543
Circulation. 2009 Sep 15;120(11 Suppl):S104-11
pubmed: 19752354
Ann Thorac Surg. 2007 Jul;84(1):92-101
pubmed: 17588392
Int J Numer Method Biomed Eng. 2017 Jun;33(6):
pubmed: 27603720
J Thorac Cardiovasc Surg. 2015 Mar;149(3):752-61.e1
pubmed: 25500293
J Thorac Cardiovasc Surg. 1998 Feb;115(2):381-6; discussion 387-8
pubmed: 9475533
Circulation. 2016 Oct 25;134(17):1247-1256
pubmed: 27777294
J Thorac Cardiovasc Surg. 2014 Jul;148(1):176-82
pubmed: 24176268
Cardiology. 2009;112(4):244-59
pubmed: 18758181
Int J Cardiol. 2012 Jun 28;158(1):71-7
pubmed: 21251720
J Thorac Cardiovasc Surg. 2010 Jul;140(1):117-21, 121.e1-3
pubmed: 20074748