[Remodeling annuloplasty using a prosthetic ring designed for correcting type-IIIb ischemic mitral regurgitation]

The most common mechanism underlying ischemic mitral regurgitation is restricted leaflet motion during systole (Carpentier's type IIIb). Annuloplasty is the preferred technique for surgical repair. The new Carpentier-McCarthy-Adams IMR Etlogix prosthetic annuloplasty ring was designed specifically to address the particular peculiarities of this condition, principally asymmetric annular dilatation. The aims of this study were to review the rationale underlying the creation of the ring and to report our early clinical experience.

The study included 40 patients with type-IIIb ischemic mitral regurgitation (grade 3+/4+) who underwent mitral value reconstruction using the new prosthetic ring between December 2003 and June 2005. Their mean age was 68+/-10 years. Concomitant procedures included coronary artery bypass grafting (n=27, 68%), tricuspid valvuloplasty (n=10, 25%), and a modified Maze procedure (n=9, 22%). The mean predicted EuroSCORE mortality for surgery was 17+/-11%.

In-hospital mortality was 2.5% (n=1). Major postoperative morbidities included one case of stroke (2.5%), one renal failure (2.5%), and four respiratory failures (10%). Predischarge echocardiography revealed no mitral regurgitation in 36 patients (92%) and mild regurgitation in three (8%). Long-term follow-up echocardiography was carried out in 36 patients (92%) after 15-34 months, and showed that the rate of recurrence of (grade >/=2+) mitral regurgitation was 3% (n=1).

The Carpentier-McCarthy-Adams IMR Etlogix(R) annuloplasty ring was effective in correcting type-IIIb ischemic mitral regurgitation. Its novel three-dimensional asymmetric shape is designed to deal with the anatomical and pathological characteristics of the condition and its use may, therefore, result in an excellent long-term outcome.