title: A Comparison of 2 Mitral Annuloplasty Rings for Severe Ischemic Mitral Regurgitation: Clinical and Echocardiographic Outcomes.
abstract: Controversies regarding the choice of annuloplasty rings for treatment of ischemic mitral regurgitation still exist. Aim of the study is to compare early performance of 2 different rings in terms of rest and exercise echocardiographic parameters (transmitral gradient, systolic pulmonary artery pressure, and mitral valve area), clinical outcomes, and recurrence of mitral regurgitation. From January 2008 till December 2013, prospectively collected data of patients who underwent coronary artery bypass grafting and undersizing mitral valve annuloplasty for severe chronic ischemic mitral regurgitation at our Institution were reviewed. A total of 93 patients were identified; among them 44 had semirigid Memo 3D ring implanted (group A) whereas 49 had a rigid profile 3D ring (group B). At 6 months, recurrent ischemic mitral regurgitation, equal or more than moderate, was observed in 4 and 6 patients in the group A and B, respectively (P = 0.74). Group A showed certain improved valve geometric parameters such as posterior leaflet angle, tenting area, and coaptation depth. Transmitral gradient was significantly higher at rest in the group B (P < 0.0001). During exercise, significant increase of transmitral gradient and systolic pulmonary artery pressure was observed in group B (P < 0.0001). Mitral valve area was not statistically significantly smaller at rest in between groups (P = 0.09); however, it significantly decreased with exercise in group B (P = 0.01). At midterm follow-up, patients in group B were more symptomatic. In patients with chronic ischemic mitral regurgitation, use of semirigid Memo 3D ring when compared to the rigid Profile 3D may be associated with early improved mitral valve geometrical conformation and hemodynamic profile, particularly during exercise. No difference was observed between both groups in recurrent mitral regurgitation.
authors.affiliation: Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy; Department of Surgery and Cancer, University of Palermo, Palermo, Italy. Electronic address: khalilfattouch@hotmail.com.
authors.forename: Khalil
authors.initials: K
authors.lastname: Fattouch
authors.affiliation: Department of Cardiovascular Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy; Nationale Heart Lung Institute, London UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Moscarelli
authors.affiliation: Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Castrovinci
authors.affiliation: Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Guccione
authors.affiliation: Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Dioguardi
authors.affiliation: Department of Cardiovascular Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Speziale
authors.affiliation: Department of Cardiology, Heart Valve Clinic, CHU Sart Tilman, GIGA Cardiovascular Sciences, University of Liege Hospital, Liege, Belgium; GVM Care and Research, E.S. Health Science Foundation, Lugo (RA), Italy.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
mesh_terms: D000368:Aged; D002908:Chronic Disease; D025401:Echocardiography, Stress / Q000379:methods; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011474:Prosthesis Design; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: Coronary artery bypass grafting (CABG); Ischemic mitral regurgitation (IMR); Mitral Regurgitation (MR); Mitral Valve Repair (MVR)