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(Circulation. 2005;112:I-402 – I-408.)
© 2005 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Mitral Valve Repair for Functional Mitral Regurgitation in End-Stage Dilated Cardiomyopathy

Role of the "Edge-to-Edge" Technique

Michele De Bonis, MD; Elisabetta Lapenna, MD; Giovanni La Canna, MD; Eleonora Ficarra, MD; Marco Pagliaro, MD; Lucia Torracca, MD; Francesco Maisano, MD; Ottavio Alfieri, MD

From the Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy

Correspondence to Dr Michele De Bonis, Cardiac Surgery Department, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy. E-mail michele.debonis{at}hsr.it

Background— The aim of this study was to assess the results of mitral valve (MV) repair in functional mitral regurgitation because of end-stage dilated cardiomyopathy (DCM).

Methods and Results— Seventy-seven patients with end-stage idiopathic (26 patients) or ischemic (51 patients) DCM underwent MV repair for functional mitral regurgitation (3 to 4+/4+). Fifty-eight patients (75.3%) were in New York Heart Association class III, and 19 (24.6%) were in IV. In 23 patients (29.8%) with a coaptation depth <1 cm, an isolated undersized annuloplasty was used. In the remaining 54 (70.1%), with a coaptation depth 1 cm, the "edge-to-edge" technique was associated with the annuloplasty. In most of the cases (88.3%), a complete rigid/semirigid ring was used. Concomitant coronary artery bypass graft was performed in 39 patients (50.6%). Hospital mortality was 3.8% (3 of 77). Actuarial survival was 90.7±3.64%, and freedom from cardiac events was 81.8±7.96% at 2.7 years. At a mean follow-up of 18.4±9.8 months (range, 1 month to 5 years) New York Heart Association class improved from 3.4±0.4 to 1.4±0.6 (P<0.0001). Mitral repair failure (recurrence of MR 3+/4+) was documented in 7 patients (9%): 2 in the edge-to-edge (2 of 54, 3.7%) and 5 in the isolated annuloplasty group (5 of 23, 21.7%) (P=0.03). Freedom from repair failure at 1.5 years was 95.0±3.4% and 77±12.1%, respectively (P=0.04). The absence of the edge-to-edge was the only predictor of repair failure (P=0.03). When residual MR was absent or mild, a reverse left ventricular remodeling was clearly documented.

Conclusions— In patients with end-stage DCM, MV repair is feasible with low hospital mortality and important symptomatic improvement. The association of the edge-to-edge technique to the undersized annuloplasty can significantly improve the durability of the repair.

Key Words: mitral regurgitation • edge-to-edge technique • dilated cardiomyopathy