title: Mitral valve repair for functional mitral regurgitation in end-stage dilated cardiomyopathy: role of the "edge-to-edge" technique.
abstract: BACKGROUND
  The aim of this study was to assess the results of mitral valve (MV) repair in functional mitral regurgitation because of end-stage dilated cardiomyopathy (DCM).
  
  
  RESULTS
  Seventy-seven patients with end-stage idiopathic (26 patients) or ischemic (51 patients) DCM underwent MV repair for functional mitral regurgitation (3 to 4+/4+). Fifty-eight patients (75.3%) were in New York Heart Association class III, and 19 (24.6%) were in IV. In 23 patients (29.8%) with a coaptation depth <1 cm, an isolated undersized annuloplasty was used. In the remaining 54 (70.1%), with a coaptation depth > or =1 cm, the "edge-to-edge" technique was associated with the annuloplasty. In most of the cases (88.3%), a complete rigid/semirigid ring was used. Concomitant coronary artery bypass graft was performed in 39 patients (50.6%). Hospital mortality was 3.8% (3 of 77). Actuarial survival was 90.7+/-3.64%, and freedom from cardiac events was 81.8+/-7.96% at 2.7 years. At a mean follow-up of 18.4+/-9.8 months (range, 1 month to 5 years) New York Heart Association class improved from 3.4+/-0.4 to 1.4+/-0.6 (P<0.0001). Mitral repair failure (recurrence of MR > or =3+/4+) was documented in 7 patients (9%): 2 in the edge-to-edge (2 of 54, 3.7%) and 5 in the isolated annuloplasty group (5 of 23, 21.7%) (P=0.03). Freedom from repair failure at 1.5 years was 95.0+/-3.4% and 77+/-12.1%, respectively (P=0.04). The absence of the edge-to-edge was the only predictor of repair failure (P=0.03). When residual MR was absent or mild, a reverse left ventricular remodeling was clearly documented.
  
  
  CONCLUSIONS
  In patients with end-stage DCM, MV repair is feasible with low hospital mortality and important symptomatic improvement. The association of the edge-to-edge technique to the undersized annuloplasty can significantly improve the durability of the repair.
authors.affiliation: Cardiac Surgery Department, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy. michele.debonis@hsr.it
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Lapenna
authors.forename: Giovanni
authors.initials: G
authors.lastname: La Canna
authors.forename: Eleonora
authors.initials: E
authors.lastname: Ficarra
authors.forename: Marco
authors.initials: M
authors.lastname: Pagliaro
authors.forename: Lucia
authors.initials: L
authors.lastname: Torracca
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D002311:Cardiomyopathy, Dilated / Q000150:complications*; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000601:surgery; D018572:Disease-Free Survival; D025401:Echocardiography, Stress; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D019736:Prostheses and Implants; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome