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Restrictive annuloplasty and coronary revascularization in ischemic mitral regurgitation results in reverse left

Jeroen J Bax1, Jerry Braun, Soeresh T Somer

  • 1Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. jbax@knoware.nl

Circulation
|September 15, 2004
PubMed

Insights

Combined coronary artery bypass grafting and restrictive annuloplasty effectively treat ischemic cardiomyopathy, significantly reducing mitral regurgitation and improving left ventricular remodeling. This procedure offers excellent long-term outcomes for patients with severe mitral regurgitation.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Cardiovascular Imaging

Background:

  • Limited data exists on combined coronary artery bypass grafting (CABG) and restrictive annuloplasty for ischemic cardiomyopathy.
  • The impact of this combined approach on left ventricular (LV) reverse remodeling remains largely unknown.

Purpose of the Study:

  • To evaluate the efficacy of combined CABG and restrictive annuloplasty in patients with ischemic cardiomyopathy and severe mitral regurgitation.
  • To assess the impact of this combined surgical strategy on mitral regurgitation, left atrial dimension, and LV reverse remodeling.

Main Methods:

  • 51 patients with ischemic LV dysfunction and severe mitral regurgitation underwent CABG and restrictive annuloplasty with mitral annulus downsizing.
  • Serial echocardiographic studies assessed mitral regurgitation, transmitral gradient, leaflet coaptation, and LV/left atrial dimensions.
  • Clinical follow-up evaluated New York Heart Association (NYHA) class, survival, and adverse events at 2 years.

Main Results:

  • The combined procedure resulted in minimal residual mitral regurgitation (grade 1+) in all patients at 2-year follow-up.
  • Significant improvements were observed in LV end-systolic and end-diastolic dimensions, indicating reverse LV remodeling.
  • Left atrial dimensions also significantly decreased, and NYHA class improved from 3.4 to 1.3.

Conclusions:

  • Combined restrictive annuloplasty and CABG yield excellent clinical and echocardiographic results.
  • The procedure effectively eliminates/minimizes mitral regurgitation and promotes significant reverse LV remodeling.
  • This surgical approach demonstrates favorable long-term outcomes, including high survival rates and improved functional class.
Abstract

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