Related Experiment Videos
Mitral annuloplasty in patients with ischemic versus dilated cardiomyopathy
Zoltan A Szalay1, Ali Civelek, Stephen Hohe
1Kerckhoff-Clinic Foundation, Benekestrasse 2-8, 61231 Bad Nauheim, Germany. sza67@web.de
Insights
Mitral annuloplasty using a flexible ring effectively treats severe mitral regurgitation in patients with end-stage cardiomyopathy, improving survival and reducing the need for cardiac transplantation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Failure Management
Background:
- Mitral regurgitation is common in end-stage cardiomyopathy and associated with poor prognosis.
- Current treatments include medical management or cardiac transplantation.
- Mitral annuloplasty offers a potential alternative for improving outcomes.
Purpose of the Study:
- To evaluate the effectiveness and safety of mitral annuloplasty with a flexible posterior ring in patients with severe cardiomyopathy and mitral regurgitation.
- To compare mid-term outcomes with conventional treatments.
Main Methods:
- 121 patients with severe dilated (DCM) or ischemic cardiomyopathy (ICM) and significant mitral regurgitation underwent mitral valve annuloplasty.
- Flexible posterior rings were used, with concomitant procedures in some patients.
- Follow-up averaged 567 days for DCM and 793 days for ICM patients.
Main Results:
- Early mortality was 6.6%, with no significant difference between DCM and ICM groups.
- Both groups showed similar improvements in NYHA class after 1 year.
- Two-year survival rates were comparable (DCM 93%, ICM 85%), with identified risk factors for failure and death.
Conclusions:
- Mitral reconstruction with a flexible posterior annuloplasty is effective and safe for patients with severely depressed left ventricular function.
- Mid-term results demonstrate superiority over medical treatment and comparability to cardiac transplantation.
Objective:
Mitral regurgitation is a frequent finding in patients with end-stage cardiomyopathy predicting poor survival. Conventional treatment consists medical treatment or cardiac transplantation. However, despite severely decreased left ventricular function, mitral annuloplasty may improve survival and reduce the need for allografts.
Methods:
From January 1996 to July 2002, 121 patients with severe end-stage dilated (DCM) or ischemic cardiomyopathy (ICM), mitral regurgitation > or =2, and left ventricular ejection fraction < or =30% underwent mitral valve annuloplasty using a flexible posterior ring. DCM was diagnosed in 30 patients (25%), whereas ICM was found in 91 patients (75%). Concomitant tricuspid valve repair was performed in 14 (46.6%) patients in the DCM, and in 11 (12%) in the ICM group (P=0.0001), coronary artery bypass grafting in three (10%) in the DCM, and in 78 patients (86%) in the ICM group (P<0.00001). The mean follow-up time was 567+/-74 days in the DCM and 793+/-63 days in the ICM group (ns).
Results:
Early mortality was 6.6% (8/121), and was equal for both groups. Improvement in NYHA class (DCM 3.3+0.1-1.8+/-0.16; ICM from 3.2+0.04 to 1.7+/-0.07) were equal between groups after 1 year. Seventeen (15%) late deaths occurred during the follow-up period. There was no difference in the 2-year actuarial survival between groups (DCM/ICM 0.93/0.85). Risk factors for mitral reconstruction failure, defined as regurgitation > or =2 after 1 year, were preoperative NYHA IV in the DCM group (P=0.03), a preoperative posterior infarction (P=0.025), decreased left ventricular function (P=0.043), larger ring size (P=0.026) and preoperative renal failure (P=0.05) in the ICM group. Risk factors for death were larger ring size (P=0.02) and an increased LVEDD (P=0.027) in the DCM group and the postoperative use of IABP (P=0.002), renal failure (P=0.001), and a larger preoperative LVESD (P=0.035) in the ICM group.
Conclusion:
Mitral reconstruction with a posterior annuloplasty using a flexible ring is effective in patients with severely depressed left ventricle function and has an acceptable operative mortality. Mid-term results are superior to medical treatment alone and comparable to cardiac transplantation.