This Article Full Text Full Text (PDF) CME: Take the course for this article: Circulation: June 2, 2009, Volume 119, Number 21 All Versions of this Article: 119/21/2837    most recent CIRCULATIONAHA.108.831412v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by de Varennes, B. Articles by Sniderman, A. Search for Related Content PubMed PubMed Citation Articles by de Varennes, B. Articles by Sniderman, A. Pubmed/NCBI databases Medline Plus Health Information Heart Attack Related Collections Congestive CV surgery: valvular disease Chronic ischemic heart disease Related Articles

(Circulation. 2009;119:2837-2843.)
© 2009 American Heart Association, Inc.

Valvular Heart Disease

Initial Results of Posterior Leaflet Extension for Severe Type IIIb Ischemic Mitral Regurgitation

Benoit de Varennes, MD; Rakesh Chaturvedi, MD; Surita Sidhu, MD; Annie V. Côté, MD; William Li Pi Shan, MD; Caroline Goyer, MD; Roupen Hatzakorzian, MD; Jean Buithieu, MD; Allan Sniderman, MD

From McGill University Health Center, Divisions of Cardiac Surgery (B.d.V., R.C.), Anesthesia (S.S., A.V.C., W.L.P.S., C.G., R.H.), and Cardiology (J.B., A.S.), Montreal, Quebec, Canada.

Correspondence to Benoit de Varennes, MD, MSc, FRCS(C), Division of Cardiac Surgery, McGill University Health Center, 687 Pine Ave W, Suite S8.86, Montreal, Quebec, Canada H3A 1A1. E-mail benoit.devarennes{at}muhc.mcgill.ca

Received October 24, 2008; accepted March 9, 2009.

Background— Management of severe ischemic mitral regurgitation remains difficult with disappointing early and intermediate-term surgical results of valve repair.

Methods and Results— Forty-four patients with severe (4+) Carpentier type IIIb ischemic mitral regurgitation underwent mitral valve repair, with or without surgical revascularization, by posterior leaflet extension with a patch of bovine pericardium and a remodeling annuloplasty. Serial echocardiography was performed preoperatively, intraoperatively, and postoperatively to assess mitral valve competence. The postoperative functional status of patients was assessed. The average Parsonnet score was 38±13. Thirty-day mortality was 11%, and late mortality was 14%. Mean follow-up was 38 months. The actuarial freedom from moderate or severe recurrent mitral regurgitation was 90% at 2 years, whereas 90% of patients were in New York Heart Association class I at 2 years.

Conclusion— Posterior leaflet extension with annuloplasty of the mitral valve for severe type IIIb ischemic regurgitation is a safe, effective method that provides good early and intermediate-term competence of the mitral valve and therefore good functional status.

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CLINICAL PERSPECTIVE

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