Surgical strategy for ischemic mitral regurgitation adopting subvalvular and ventricular procedures.
OBJECTIVE
The progression of left ventricular (LV) remodeling and subsequent mitral valve tethering impair the results of reduction annuloplasty for ischemic mitral regurgitation (MR).


METHODS
We studied 90 patients who underwent surgical repair of ischemic MR between 1999 and 2013 according to our surgical strategy adding submitral and ventricular procedures to annuloplasty as follows: annuloplasty alone (stage 1, n = 30), additional papillary muscle approximation (PMA) for progression of tethering (stage 2, n = 26), and additional left ventriculoplasty with PMA for progression of LV remodeling and tethering (stage 3, n = 34).


RESULTS
The preoperative New York Heart Association (NYHA) functional classes (2.5 ± 0.7, 3.1 ± 0.7 and 3.3 ± 0.7 for stages 1, 2 and 3, respectively, P <0.001), LV end-diastolic diameters (56 ± 7 mm, 66 ± 5 mm and 70 ± 7 mm, P <0.001), and LV ejection fractions (45 ± 12%, 32 ± 9% and 27 ± 9%, P <0.001) significantly differed among the stages. In contrast, the MR grades did not significantly differ (2.9 ± 0.8, 3.0 ± 1.0, and 2.9 ± 1.1, respectively; P = 0.93). Both the rates of cardiac-related survival and freedom from reoperation were comparable among the 3 groups (log-rank P = 0.92 and 0.58, respectively).


CONCLUSIONS
Additional submitral and ventricular procedures can compensate for the possible impairment of the outcomes after annuloplasty alone for ischemic MR in patients with severe LV remodeling and tethering.
Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Satoru
S
Wakasa
Yasushige
Y
Shingu
Tomonori
T
Ooka
Hiroki
H
Katoh
Tsuyoshi
T
Tachibana
Yoshiro
Y
Matsui
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009202:Cardiomyopathies / Q000150:complications; D003324:Coronary Artery Disease / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D010210:Papillary Muscles / Q000601:surgery; D011182:Postoperative Care; D011300:Preoperative Care; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome