title: Five-year echocardiographic results of combined undersized mitral ring annuloplasty and coronary artery bypass grafting for chronic ischaemic mitral regurgitation.
abstract: OBJECTIVE
  We present 5-year echocardiographic results of combined undersizing mitral ring annuloplasty (UMRA) and coronary artery bypass grafting (CABG) in chronic ischaemic mitral regurgitation (CIMR).
  
  
  RESULTS
  Two hundred and fifty-one patients (aged 68.4 +/- 8.1, 62.5% male) undergoing combined CABG and UMRA in our Institution (Cardiac Surgery, Careggi Hospital, Florence, Italy) between September 2001 and March 2007 were prospectively enrolled in the study. Median follow up was 32.9 months [interquartile range (IQR) 17.5-51.6]. Fourteen patients with significant residual mitral regurgitation (MR) needing immediate intraoperative revision (n = 3) or at discharge (n = 11) were excluded from the study. Serial echocardiograms were performed in 220 survivors at baseline, discharge, and annually thereafter. Additionally, 17 patients died (2 early and 15 late deaths) and were also excluded from the study. MR remained stable at 1 year and re-increased at 3 years (P < 0.001) and 5 years (P < 0.001). Five-year actuarial survival was 83.2 +/- 4.4. Five-year freedom from re-operation for failed repair was 78.2 +/- 4.9%. Mean systolic and diastolic diameters decreased significantly at discharge (P = 0.001 and P = 0.01, respectively) and at early follow up (P = 0.004 and P = 0.02) but raised at 3 years (P < 0.001) and 5 years (P < 0.001). Systolic and diastolic sphericity indexes improved at discharge (P < 0.001) remained stable at 1 year but they re-increased at 3-year control (P = 0.006 and P = 0.03, respectively) with a late raise exceeding the pre-operative value (P < 0.001). Left ventricular reverse remodelling was observed in 44.2% of the study population with 10.3% of patients showing further left ventricular dilatation. At multivariable model, end-systolic volume > or =145 mL, systolic sphericity index > or =0.7, myocardial performance index > or =0.9, and wall motion score index > or =1.5 were predictors of recurrent MR.
  
  
  CONCLUSIONS
  Our findings emphasize the need for improved repair technique and better patient selection to identify patients with anticipated repair failure who could benefit more from valve replacement or other procedure directly addressing ventricular tethering.
authors.affiliation: Department of Heart and Vessels, Careggi HospitalViale Morgagni 85, 50134 Florence, Italy. sandro.gelsomino@libero.it
authors.forename: Sandro
authors.initials: S
authors.lastname: Gelsomino
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Cicco
authors.forename: Irene
authors.initials: I
authors.lastname: Capecchi
authors.forename: Carlo
authors.initials: C
authors.lastname: Rostagno
authors.forename: Sabina
authors.initials: S
authors.lastname: Caciolli
authors.forename: Stefano
authors.initials: S
authors.lastname: Romagnoli
authors.forename: Ugo
authors.initials: U
authors.lastname: Da Broi
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Stefàno
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
mesh_terms: D000368:Aged; D002908:Chronic Disease; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome; D014463:Ultrasonography; D020257:Ventricular Remodeling / Q000502:physiology*