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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Selective treatment algorithm for mitral valve annuloplasty in nonischemic functional mitral regurgitation
Shao-Wei Chen1, Feng-Chun Tsai, Feng-Chang Tsai
1Section of Cardiac Surgery, Chang Gung Institute of Technology, Chia-Yi, Taoyuan, Taiwan.
Journal of Cardiac Failure
|April 29, 2009
Summary
Mitral annuloplasty (MA) is effective for functional mitral regurgitation (FMR) in nonischemic dilated cardiomyopathy (DCM) patients. The procedure demonstrated feasible and reasonable short- and long-term outcomes in this patient group.
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Failure Management
Background:
- Functional mitral regurgitation (FMR) in nonischemic dilated cardiomyopathy (DCM) presents variable outcomes with mitral annuloplasty (MA).
- Patients with advanced heart failure symptoms (NYHA class III-IV) despite maximal medical therapy were included.
- Exclusion criteria ensured a focused cohort, excluding coronary artery disease and primary valve pathologies.
Purpose of the Study:
- To evaluate the effectiveness of mitral annuloplasty (MA) in patients with nonischemic dilated cardiomyopathy (DCM) and functional mitral regurgitation (FMR).
- To assess the procedural feasibility and patient outcomes following a selective treatment protocol.
Main Methods:
- Retrospective analysis of 42 patients with nonischemic DCM and FMR undergoing MA between April 2003 and December 2007.
- Utilized downsized Carpentier-Edwards Physio annuloplasty rings, with concomitant tricuspid valve repair and Maze procedures performed as needed.
- Echocardiographic follow-up at early, short-term, and midterm intervals assessed left heart reverse remodeling and performance; survival and readmission data were collected.
Main Results:
- Successful MA achieved significant improvement in NYHA functional class (3.2 to 1.3) and ejection fraction.
- Actuarial survival rates were 88.9% at 1 year and 79.2% at 3 years, with low in-hospital mortality (2.4%).
- Eight patients (19.5%) were readmitted for heart failure; echocardiography confirmed left heart reverse remodeling and improved function.
Conclusions:
- Mitral annuloplasty (MA) is a feasible and effective treatment for functional mitral regurgitation (FMR) in selected patients with nonischemic dilated cardiomyopathy (DCM).
- The procedure is associated with favorable short- and long-term clinical outcomes, including improved functional status and reverse remodeling.
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