Abstract 3242: The Geoform Annuloplasty Ring for the Surgical Treatment of Functional Mitral Regurgitation in Advanced Dilated Cardiomyopathy
Objective: To assess the results of the 3D-shaped GeoForm ring for the treatment of functional mitral regurgitation (FMR).
Methods: Sixty patients with FMR and severe LV dysfunction underwent GeoForm ring implantation. Thirty-seven patients (61.6%) were in NYHA class III-IV. Concomitant procedures were CABG (29 pts), tricuspid repair (19 pts) and atrial fibrillation ablation (18 pts).
Results: Hospital mortality was 6.6%. At a mean follow-up of 12.4 months, MR was absent or mild in 49 patients (81.6%), moderate (2+/4+) in 7 patients (11.6%) and ≥3+/4+ in 4 (6.6%). Actuarial freedom from MR≥3+ was 92±5.4% at 2 years. The presence of asymmetric tethering with prevalent restricted motion of the posterior leaflet was identified as a predictor of recurrence of MR (OR 7.0, p=0.008). Echocardiography showed a significant decrease in LVEDVi (p=0.0001), LVESVi (p=0.02), LVEDDi (p=0.001), LVESDi (p=0.04) and SPAP (p=0.0001). Ejection fraction increased from 34.3±8.7% to 40±9.9% (p<0.0001). Stress echocardiography was performed in a subgroup of patients with small rings (mostly number 26). Mean mitral area at rest was 2.2±0.3 cm2 and did not change during stress. Cardiac output significantly increased in all patients during exercise. Mean and peak transmitral gradients were 3.3±1.3 and 8.1±2.2 mmHg at rest and 6.6±2.5 and 14.8±3.9 mmHg under stress respectively (both p<0.003).
Conclusions: The GeoForm ring is effective in relieving FMR in most of the patients with dilated cardiomyopathy. In presence of prevalent restricted motion of the posterior leaflet recurrence of significant MR is more likely to occur. Clinically relevant mitral stenosis was not detected during exercise.