Left ventricular reverse remodeling after undersized mitral ring annuloplasty in patients with ischemic regurgitation.
BACKGROUND
Long-term durability of combined coronary artery bypass grafting and of undersized mitral ring annuloplasty (UMRA) is uncertain. A considerable number of patients show recurrent regurgitation. This study examines the difference in the benefit of UMRA on clinical end points and recurrence of mitral regurgitation between responders and nonresponders of left ventricular reverse remodeling.


METHODS
Study eligibility criteria were fulfilled by 204 patients with chronic ischemic mitral regurgitation (CIMR) who survived combined coronary artery bypass grafting and reductive annuloplasty between September 2001 and September 2006. Patients underwent echocardiography preoperatively, at discharge, and at follow-up appointments (100% complete). Median early follow-up was 6 months (interquartile range [IRQ], 3 to 8 months; late follow-up, 35 months (IRQ, 21 to 50 months). Reverse remodeling was considered a reduction in left ventricular end systolic volume index exceeding 15%.


RESULTS
There were 84 responders (41.2%) of reverse remodeling (age, 68 +/- 7.4 years; 51 men) and 120 nonresponders (58.8%; age, 67 +/- 7.6 years; 78 men). Nonresponders had a higher recurrence of mitral regurgitation (p < 0.001), higher reoperation rate for failed repair (p < 0.001), and significantly larger left ventricular volumes and dimension at any study point (p < 0.001), with significant late increase of sphericity indexes exceeding preoperative values (p < 0.001). At multivariable analysis, a baseline myocardial performance index of less than 0.90 (p < 0.001), a systolic sphericity index of less than 0.72 (p < 0.001), and wall motion score index of less than 1.59 (p = 0.003) were independent predictors of reverse remodeling.


CONCLUSIONS
Our experience suggests that more information on possible echo predictors of an inadequate result may improve preoperative decision making of CIMR patients for UMRA.
Gelsomino
Sandro
S
Experimental Surgery Unit, Cardiac Surgery Unit, Department of Heart and Vessels, Careggi Hospital, Florence, Italy. sandro.gelsomino@libero.it
Lorusso
Roberto
R
Capecchi
Irene
I
Rostagno
Carlo
C
Romagnoli
Stefano
S
Billè
Giuseppe
G
De Cicco
Giuseppe
G
Tetta
Cecilia
C
Stefàno
Pierluigi
P
Gensini
Gian Franco
GF
D000367:Age Factors; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D011336:Probability; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D020257:Ventricular Remodeling