Abstract 2708: Long-Term Outcome After Restrictive Annuloplasty and Coronary Revascularization in Ischemic Mitral Regurgitation
Objectives Long-term follow-up data, including echocardiographic evaluation of reverse left ventricular (LV) remodeling, on combined coronary artery bypass grafting (CABG) and restrictive annuloplasty in patients with ischemic cardiomyopathy and severe ischemic mitral regurgitation (MR) are scarce.
Methods Eighty-five patients (67±9 years) with previous infarction (>3 months before the study), LV dysfunction and severe MR (grade 3– 4+) underwent CABG and restrictive annuloplasty with stringent downsizing of the mitral annulus (by 2 ring sizes, Physio-ring, mean size 26±2 mm). All patients underwent clinical and echocardiographic evaluation before surgery: NYHA class, left atrial (LA) and LV dimensions, severity of MR and leaflet coaptation were determined. Patients were re-evaluated at 4-year follow-up.
Results Early mortality was 8% (7 pts, 4 cardiac deaths). Late mortality was 15% (13 pts, 7 cardiac deaths). Median follow-up of the survivors was 43 months. As compared to survivors, patients who died had larger LA dimension (53.6±9.8 mm vs 45.2±7.1 mm, p<0.0001) and larger LV dimension: LV end-diastolic diameter 65.7±7.3 mm vs 59.5±9.1 mm and LV end-systolic diameter 53.2±9.1 mm vs 45.8±10.8 mm, p<0.001. In the survivors, NYHA class improved from 2.9±1 to 1.2±0.4 (p<0.0001); all patients were free of endocarditis, free of thrombo-embolism, 2 (2%) needed re-operation for recurrent MR and 2 patients underwent PCI. LV end-diastolic and end-systolic dimensions decreased from 59.8±9.0 mm to 54.2±9.7 mm (p<0.0001) and from 46.3±10.6 mm to 39.3±11.6 mm (p<0.0001) respectively. LA dimension was reduced from 45±7mm to 42±7 mm (p<0.01). Leaflet coaptation improved from 0.3±0.2 mm to 0.8±0.2 and MR grade decreased from 3.0±0.6 to 0.8±0.8 at follow-up (p<0.0001).
Conclusion The current data confirm excellent clinical results of restrictive annuloplasty in addition to revascularization in patients with ischemic MR. Residual MR was absent at 4-year follow-up, associated with a significant reduction in LA dimension and significant LV reverse remodeling.