title: A prospective study of predicting factors in ischemic mitral regurgitation recurrence after ring annuloplasty.
abstract: BACKGROUND
  Ischemic mitral regurgitation (IMR) is a complex lesion to repair, and its successful management requires an understanding of its mechanism and severity. Ring annuloplasty, currently the surgical treatment of choice for IMR, has failure rates as high as 30% in patients with functional IMR. We sought to study the variables that can predict IMR recurrence after ring annuloplasty.
  
  
  METHODS
  This is a prospective study of 114 patients with 3+ to 4+ IMR who underwent coronary artery bypass grafting and mitral valve annuloplasty with acceptable results at an approximately 2-year follow-up. Variables were compared in a failure group, comprising patients with 2+ or higher MR and a nonfailure group, consisting of those with less than +2 MR.
  
  
  RESULTS
  There were five postoperative in-hospital deaths. During follow-up, 14 patients died and 95 patients were evaluated. After a mean follow-up of 22.2 +/- 4.6 months for the nonfailure group and 18.6 +/- 5.6 months for the failure group, 23 patients (24.4%) exhibited annuloplasty failure. Some variables had an effect in our univariate analysis, but only interpapillary muscle distance had a relationship with recurrent MR in the multivariate analysis. Mean preoperative interpapillary muscle distance was 15.0 +/- 4.0 and 26.5 +/- 2.9 in the nonfailure group and failure group, respectively (p < 0.0001).
  
  
  CONCLUSIONS
  Interpapillary muscle distance, as a reliable index of dysfunctional subvalvular apparatus in patients with IMR, can predict late postrepair MR and indicate the need for a procedure complementary to annuloplasty.
authors.affiliation: Day General Hospital, Tehran, Iran. farideh_roshanali@yahoo.com
authors.forename: Farideh
authors.initials: F
authors.lastname: Roshanali
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Mandegar
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Yousefnia
authors.forename: Hussein
authors.initials: H
authors.lastname: Rayatzadeh
authors.forename: Farshid
authors.initials: F
authors.lastname: Alaeddini
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000601:surgery*; D011446:Prospective Studies; D012372:ROC Curve; D012008:Recurrence; D018487:Ventricular Dysfunction, Left / Q000209:etiology