Restrictive annuloplasty on remodeling and survival in patients with end-stage ischemic cardiomyopathy
Yusuke Misumi1, Satoshi Kainuma1, Koichi Toda1
1Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Insights
Adding restrictive mitral annuloplasty (RMA) during coronary artery bypass grafting (CABG) significantly improves left ventricular (LV) reverse remodeling in ischemic cardiomyopathy patients. However, its impact on long-term survival requires further investigation.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Heart Failure Research
Background:
- Ischemic cardiomyopathy (ICM) significantly impacts left ventricular (LV) function.
- Coronary artery bypass grafting (CABG) is a primary treatment for ICM.
- Mitral regurgitation (MR) is a common complication in ICM, affecting prognosis.
Purpose of the Study:
- To evaluate the effect of concomitant restrictive mitral annuloplasty (RMA) on LV reverse remodeling after CABG in ICM patients.
- To assess the impact of RMA on overall survival in this patient cohort.
Main Methods:
- A study involving 157 patients with ICM (LV ejection fraction ≤40%) undergoing CABG.
- 84 patients received concomitant RMA for significant ischemic MR.
- Echocardiography at 1-year post-surgery assessed LV end-systolic volume index (LVESVI); survival was tracked for a median of 5.1 years.
Main Results:
- Patients undergoing CABG with RMA had larger baseline LVESVI.
- CABG with RMA resulted in a greater reduction in LVESVI at 1 year (37%) compared to CABG alone (21%).
- Concomitant RMA was significantly associated with LV reverse remodeling (OR, 2.79; P=.006), but survival rates were similar between groups.
Conclusions:
- Concomitant RMA significantly enhances LV reverse remodeling in patients with ICM undergoing CABG.
- The effect of this improved LV remodeling on long-term survival remains to be determined.
Objectives:
To elucidate the influence of concomitant restrictive mitral annuloplasty (RMA) on postoperative left ventricular (LV) reverse remodeling and survival in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG).
Methods:
This study comprised 157 patients with ischemic cardiomyopathy (LV ejection fraction ≤40%) who underwent CABG and completed echocardiographic examination at 1 year after surgery, with 84 (54%) undergoing concomitant RMA for clinically relevant ischemic mitral regurgitation. The primary end point was postoperative reduction in LV end-systolic volume index (LVESVI). The secondary end point was overall survival. Median follow-up was 5.1 years.
Results:
At baseline, patients who underwent CABG with RMA had a larger LVESVI (83 ± 23 vs 75 ± 24 mm; P = .046). One-year postoperatively, CABG with RMA reduced the LVESVI more than did CABG alone (37% vs 21% from baseline; P < .001), yielding nearly identical postoperative LVESVI (53 ± 27 vs 61 ± 26 mm; P = .065). In multivariable logistic regression analysis, concomitant RMA was associated with significant LV reverse remodeling (odds ratio, 2.79; 95% CI, 1.34-5.78; P = .006). The prevalence in moderate or severe mitral regurgitation was not different between the groups (7% vs 10%; P = .58). Survival rates were similar between the groups (5 years, 78% vs 83%; P = .35).
Conclusions:
In patients with ischemic cardiomyopathy undergoing CABG, concomitant RMA was associated with significant reduction in LVESVI. The influence of LV reverse remodeling on survival remains undetermined.
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