Mitral stenosis after IMR ETlogix ring annuloplasty for ischemic regurgitation

Ring annuloplasty combined with coronary artery bypass grafting is the standard approach for treatment of patients with ischemic mitral regurgitation. We evaluated mitral valve hemodynamic performance and recurrence of mitral regurgitation after ring annuloplasty.

40 consecutive patients (mean age, 70±8 years) with chronic ischemic mitral regurgitation grade ≥2+ received annuloplasty with an IMR ETlogix ring. During follow-up (25.9±15.5 months), 84% of surviving patients underwent exercise stress echocardiography to assess recurrence of mitral regurgitation and differences between rest and exercise mitral valve hemodynamic performance.

Hospital mortality was 10%. During follow-up, we found no significant differences between left ventricular ejection fraction or end-diastolic and end-systolic diameters pre- and postoperatively (41% vs. 45%, 59 vs. 56 mm, and 49 vs. 46 mm, respectively), but there was a significant increase in mitral mean gradient with exercise (3.3±1.2 vs. 7.8±4 mmHg, p<0.001). Two patients had mitral regurgitation ≥grade III-IV.

Mitral annuloplasty with the IMR ETlogix ring provides effective correction of chronic ischemic mitral regurgitation, but this technique may induce functional mitral stenosis.