title: Five-year real world outcomes of GeoForm ring implantation in patients with ischemic mitral regurgitation.
abstract: BACKGROUND
  Reductive ring annuloplasty represents the current standard surgical therapy for ischemic mitral regurgitation (IMR); however, the clinical results have been suboptimal. Etiology-specific prostheses such as the GeoForm annuloplasty ring have been designed to better address the annular and subvalvular perturbations associated with IMR. However, clinical experience is limited, and mid-term results are lacking.
  
  
  METHODS
  We reviewed the clinical outcomes of 86 patients who had undergone implantation of a GeoForm ring at our center from 2005 to 2011. Perioperative mortality and clinical parameters were derived from The Society of Thoracic Surgeons database. Follow-up survival was assessed using the Social Security Death Index. Surviving patients were interviewed by telephone for valve-specific follow-up data and to complete the Medical Outcomes Study, short-form, 36-item, quality-of-life questionnaire.
  
  
  RESULTS
  The mean grade of IMR preoperatively was 3.1±0.8 (range, 1-4+), 0.2±0.4 in the immediate postoperative period, and 0.7±0.7 at the last mean follow-up point of 41 months; only 2 patients developed ≥2+IMR during the follow-up period, for a 5-year freedom from recurrent 2+ IMR of 86%. The mean left ventricular end-diastolic and end-systolic diameters decreased from before to after surgery from 6.0±0.0 cm to 5.3±09 cm and 5.0±0.9 cm to 4.3±1.1 cm, respectively (P<.001). Perioperative mortality was 5.8% (5 of 86), and 1-, 3-, and 5-year survival was 87%, 81%, and 75%, respectively. At the last follow-up point, 80% of patients were in New York Heart Association class I and II, and their quality of life was equal to, or better than, age-matched controls from the general population.
  
  
  CONCLUSIONS
  Implantation of the GeoForm ring offers very good control of IMR, with low rate of recurrent IMR at mid-term follow-up. The use of this prosthesis was associated with good perioperative mortality, mid-term survival, and quality of life.
authors.affiliation: Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Mich. Electronic address: timek@wmcts.com.
authors.forename: Tomasz A
authors.initials: TA
authors.lastname: Timek
authors.affiliation: Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Mich.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Hooker
authors.affiliation: Michigan State University College of Human Medicine, Grand Rapids, Mich.
authors.forename: Robin
authors.initials: R
authors.lastname: Collingwood
authors.affiliation: Grand Rapids Education Partners, Grand Rapids, Mich.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Davis
authors.affiliation: Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Mich.
authors.forename: Craig T
authors.initials: CT
authors.lastname: Alguire
authors.affiliation: Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Mich.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Willekes
authors.affiliation: Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Mich.
authors.forename: Edward T
authors.initials: ET
authors.lastname: Murphy
authors.affiliation: Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Mich.
authors.forename: John C
authors.initials: JC
authors.lastname: Heiser
authors.affiliation: Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Mich.
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Patzelt
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D011474:Prosthesis Design; D011788:Quality of Life; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome