Abstract 3382: The Geoform Ring: Mechanism Specific Therapy for Ischemic and Myopathic Mitral Regurgitation
Objective: Surgical treatment of ischemic and myopathic MR with mitral valve repair (MVr), remains controversial. Excellent short-term results have been reported, but residual/recurrentMR and limited LV reverse remodeling hinder long term improvement and obscure any possible mortality benefit. Presently however, the mechanism of ischemic and myopathic MR is better understood as ventricular in origin. This study reviewed mid-term outcomes of patients who underwent MVr with the GeoForm ring, a mechanism specific LV remodeling ring that utilizes 3D spatial dimensions to re-establish mitral coaptation and favorably alter LV geometry, from the annular level.
Methods: Prospectively, 30 pts with enlarged hearts (LVIDd 68+9 mm, all >50 mm) underwent MVr for functional MR using a 26/28 mm GeoForm ring, designed to reduce annular septal-lateral diameter and attenuate adverse LV geometry. The mean age was 60±10 years. At presentation, mean NYHA was >2 in 95%, LVEF was 31±12% and all patients had >3+ MR. Concomitant procedures included CABG in 5, TVr - 14, Maze - 11; redo - 5 (prev CABGs). All patients had anatomically normal mitral valves, with MR due to LV geometric distortion including tenting, inferobasilar LV migration, apical displacement, annular dilation and posterior leaflet restriction.
Results: There was a 0% 30-day mortality. On intraop TEE, there was no MR(2-trivial), no SAM or MS. At discharge, LVIDd was reduced from 68+9 to 61+9 mm(p<.05). Mean follow-up was 32+10 months. At 3 and 6 months, LVIDd was reduced and stable at 59+9 and 59+9 mm, respectively(both p<.05). There was one ring dehiscence. All pts had favorable changes in LV geometry with decreased LV volumes, sphericity and tenting, and an increase in EF. On 3D echos performed, there was better stress-strain coupling of the inferobasilar LV segments. By 6 months, 95% of pts were in NYHA <2. There was no late MS. There were 3 late CHF deaths and KM survival at 36 months was 89%.
Conclusion: Functional MR from LV geometric distortion does not preclude successful MVr. The GeoForm ring offers a simple mechanism-specific strategy for ischemic and myopathic, CHF-related MR. The Geoform ring led to stable elimination of MR and reverse remodeled LV geometry, which could potentially benefit survival for CHF patients