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(Circulation. 2006;114:I-588 – I-593.)
© 2006 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Mitral Valve Repair With Carpentier-McCarthy-Adams IMR ETlogix Annuloplasty Ring for Ischemic Mitral Regurgitation

Early Echocardiographic Results From a Multi-Center Study

Masao Daimon, MD; Shota Fukuda, MD; David H. Adams, MD; Patrick M. McCarthy, MD; A. Marc Gillinov, MD; Alain Carpentier, MD; Farzan Filsoufi, MD; Vivian M. Abascal, MD; Vera H. Rigolin, MD; Sacha Salzberg, MD; Anna Huskin, RN; Michelle Langenfeld, RN; Takahiro Shiota, MD

From Cleveland Clinic Foundation (M.D., S.F., A.M.G., T.S.), Cleveland, Ohio; Mount Sinai Medical Center (D.H.A., A.C., F.F., V.M.A., S.S.), New York, NY; Northwestern University’s Feinberg School of Medicine/Bluhm Cardiovascular Institute (P.M.M., V.H.R., A.H., M.L.), Chicago, Ill.

Correspondence to Takahiro Shiota, Department of Cardiovascular Medicine - Desk F15, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail shiotat{at}ccf.org

Background— Ischemic mitral regurgitation (IMR) is associated with asymmetric changes in annular and ventricular geometry. Surgical repair with standard symmetric annuloplasty rings results in a high incidence of residual or recurrent mitral regurgitation (MR). The Carpentier-McCarthy-Adams (CMA) IMR ETlogix annuloplasty ring is the first remodeling ring specifically designed to treat asymmetric leaflet tethering and annular dilatation. We used quantitative 2-dimensional echo to examine early results of mitral valve (MV) repair with the CMA IMR ETlogix annuloplasty ring in patients with IMR.

Methods and Results— Fifty-nine patients (aged 68±12 years) with grade 2+ IMR (graded on a scale of 0 to 4+) underwent MV repair with the CMA IMR ETlogix annuloplasty ring. We assessed the mitral annular diameter (MAD), tethering area (TA), and tenting height (TH) of the MV in 4-chamber, 2-chamber, and long axis views at mid-systole before and 3 to 10 days after surgery. After surgery, 57 of 59 (97%) patients had grade 0 or 1+ MR, whereas 2 patients had 2+ MR. MV repair with the CMA IMR ETlogix ring significantly reduced MAD, TA, and TH (P<0.001, for all 3 echo views), particularly in the long axis and 4-chamber views.

Conclusion— Surgical repair of IMR with the novel asymmetric CMA IMR ETlogix annuloplasty ring provided excellent early results with effective reduction of MR, MAD, and leaflet tethering. This novel etiology-specific strategy may result in improved outcomes in IMR patients.

Key Words: echocardiography • mitral valve • myocardial infarction • regurgitation

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