Restrictive mitral valve annuloplasty for chronic ischemic mitral regurgitation: a 5-year clinical experience with the physio ring.
BACKGROUND
This study investigated the results of restrictive mitral annuloplasty with the semirigid Carpentier-Edwards Physio ring in patients with moderately severe to severe chronic ischemic mitral regurgitation (IMR) and advanced ischemic cardiomyopathy (ICM).


METHODS
From 2003 to 2007, 100 consecutive patients (mean age +/- SD, 69 +/- 10 years) with chronic IMR of grades 3 to 4 (3.6 +/- 0.5) and a left ventricular ejection fraction (LVEF) of 31% +/- 9% (range, 12%-45%) underwent standardized restrictive prosthetic ring annuloplasty (ie, downsizing of 2.7 +/- 1.0 [range, 2-4] ring sizes) and concomitant coronary artery bypass grafting. All surviving patients were restudied 8 +/- 1 days, 3 +/- 1 months, and 2.5 +/- 1.0 years after surgery to assess survival, residual MR, New York Heart Association (NYHA) class, and LV function (end-systolic and end-diastolic dimension/volume indices and LVEF). Data were analyzed exploratatively.


RESULTS
Survival rates at the postoperative reexamination times were 98%, 97%, and 94%, respectively (1 noncardiac and 5 cardiac deaths). NYHA class improved from 3.5 +/- 0.5 to 1.4 +/- 0.5 (P < .0005). The residual MR grades at discharge, early follow-up, and late follow-up were 0.4 +/- 0.5, 0.5 +/- 0.5, and 0.4 +/- 0.6, respectively (P < .0005). Post-operative recurrence of significant IMR (>grade 2) was absent in all patients. The leaflet coaptation height was 8 +/- 1 mm and did not decrease significantly over time. All LV dimension and volume indices and the LVEF (41% +/- 9% at 2.5 years) improved significantly after surgery (P < .0005), even in patients with initially severely reduced myocardial function and a preoperative LVEF of <30% (n = 42; LVEF, 22% +/- 5% versus 33% +/- 6% at late follow-up; P < .0005).


CONCLUSIONS
Restrictive mitral valve annuloplasty using the semirigid Physio ring corrected chronic IMR in ICM patients with very low mortality and improved contractility. Surgery also prevented recurrence of significant IMR in parallel with the phenomenon of postoperative continuous reverse myocardial remodeling.
Geidel
Stephan
S
Hanseatisches Herzzentrum, Abteilung für Herzchirurgie, Asklepios Klinik St. Georg, Hamburg, Germany. StGeidel@aol.com
Lass
Michael
M
Ostermeyer
Jörg
J
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D001026:Coronary Artery Bypass; D004452:Echocardiography; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000503:physiopathology; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D066298:In Vitro Techniques; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications*; D012720:Severity of Illness Index; D013318:Stroke Volume; D016019:Survival Analysis; D016896:Treatment Outcome