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(Circulation. 2003;108:II-241.)
© 2003 American Heart Association, Inc.

Cardiac Transplantation and Surgery for Congestive Heart Failure

Importance of Mitral Valve Repair Associated With Left Ventricular Reconstruction for Patients With Ischemic Cardiomyopathy: A Real-Time Three-Dimensional Echocardiographic Study

Jian Xin Qin, MD; Takahiro Shiota, MD, PhD; Patrick M. McCarthy, MD; Craig R. Asher, MD; Melanie Hail, RN; Deborah A. Agler, RDCS; Zoran B. Popovi, MD; Neil L. Greenberg, PhD; Nicholas G. Smedira, MD; Randall C. Starling, MD; James B. Young, MD; James D. Thomas, MD

Received From the Departments of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery and the Kaufman Center for Heart Failure, The Cleveland Clinic Foundation, Cleveland, OH

Correspondence to Takahiro Shiota, MD, PhD, Department of Cardiovascular Medicine—Desk F15, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195. Phone: 216-445-7287; Fax: 216-445-4419; E-mail: shiotat{at}ccf.org

Background— Left ventricular (LV) reconstruction surgery leads to early improvement in LV function in ischemic cardiomyopathy (ICM) patients. This study was designed to evaluate the impact of mitral valve (MV) repair associated with LV reconstruction on LV function 1-year after surgery in ICM patients assessed by real-time 3-dimensional echocardiography (3DE).

Methods and Results— Sixty ICM patients who underwent the combination surgery (LV reconstruction in 60, MV repair in 30, and revascularization in 52 patients) were studied. Real-time 3DE was performed and LV volumes were obtained at baseline, discharge, 6-month and 12-month follow-up. Reduction in end-diastolic volumes (EDV) by 29% and in end-systolic volumes by 38% were demonstrated immediately after surgery and remained at subsequent follow-up (P<0.0001). The LV ejection fraction significantly increased by about 10% at discharge and was maintained 12-month (P<0.0001). Although the LV volumes were significantly larger in patients with MV repair before surgery (EDV, 235±87 mL versus 193±67 mL, P<0.05), they were similar to LV volumes of the patients without MV repair at subsequent follow-ups. However, the EDV increased from 139±24 mL to 227±79 mL (P<0.01) in 7 patients with recurrent mitral regurgitation (MR). Improvement in New York Heart Association functional class occurred in 81% patients during late follow-up.

Conclusion— Real-time 3DE demonstrates that LV reconstruction provides significant reduction in LV volumes and improvement in LV function which is sustained throughout the 1-year follow-up with 84% cardiac event free survival. If successful, MV repair may prevent LV redilation, while recurrent MR is associated with increased LV volumes.

Key Words: cardiomyopathy • ischemia • cardiac volume • surgery • echocardiography