Abstract 3681: Mitral Repair for Functional Mitral Regurgitation in Idiopathic Dilated Cardiomyopathy: Improved Outcome With Ablation of Atrial Fibrillation and/or Resynchronization Therapy
PURPOSE: To assess if the addition of cardiac resynchronization therapy (CRT) and/or ablation of AF improves the outcome of patients undergoing mitral repair for functional mitral regurgitation (MR) in idiopathic dilated cardiomyopathy (iDCM).
METHODS: Forty-eight iDCM patients (mean EF 29±7.2%) were submitted to mitral repair for functional MR; 36 were in NYHA class III or IV. Radiofrequency ablation of AF was performed in 15 patients (31.2%), CRT was added later in 19 cases (39.5%). Overall 24 (50%) of the patients received CRT and/or successful AF ablation.
RESULTS: No hospital deaths occurred. Actuarial survival was 85±6.9% at 3.5 years. Preoperative EF was a predictor of late mortality (p=0.02, HR 0.76). At a median follow-up of 19.6 months, 36 patients (75%) had no or mild MR, 9 patients (18.7%) had 2+/4+ and 3 patients (6.2%) had MR ≥3+. Freedom from MR≥3+ was 94±4.1% at 3.5 years. Patients submitted to successful ablation of AF and/or CRT had a significantly better outcome with a decrease of LV dimensions and NYHA class and an increase of EF. In particular 58% of them showed a 10-point increase in EF at last follow-up whereas only 20% of the patients with isolated mitral repair reached this same endpoint (p=0.01). Mean EF at follow-up was 42±9.8% in the first group and 34±11% in the second (p=0.01).
CONCLUSIONS: In patients with iDCM and functional MR, the addition of ablation of AF and/or CRT to mitral repair provides a significant advantage in terms of improvement of LV dimensions and function and clinical outcome.