Abstract 4170: Angiographic and Echocardiographic Results of Restrictive Mitral Annuloplasty for Ischemic Mitral Regurgitation With Left Ventricular Dysfunction
Objectives: Ischemic mitral regurgitation (IMR) associated with left ventricular (LV) dysfunction remains a surgical challenge. We investigated the effects of restrictive mitral annuloplasty (RMA) for IMR on early and late outcomes of patients with LV dysfunction.
Methods: From 1998 to 2008, 28 consecutive patients with IMR associated with LV dysfunction (EF <40%) underwent undersized RMA (mean ring size: 25±1 mm). Cardiac catheterization was examined at baseline and 1 month after surgery. Serial echocardiograms were performed to evaluate tenting area (TA), papillary muscle distance (PMD), residual mitral regurgitation (MR), LV end-diastolic dimension, EF, and estimated systolic pulmonary arterial pressure (sPAP) at baseline, 1 month after surgery, and annually thereafter.
Results: Twenty-three of the patients underwent concomitant CABG (mean distal anastomoses: 2.3±1.0). Hospital mortality was 3.6% (1 patient). Reduction in LV volume and an associated decrease in LV end-diastolic pressure were demonstrated by cardiac catheterization (Table⇓). All patients were discharged with no (0) or mild (1) MR with significant improvements in TA, and PMD. After 3 years, improvements in LV reverse remodeling, LV systolic function, and sPAP were well maintained (Table⇓), clinical symptoms improved (NYHA class: 3.3±0.5 to 1.4±0.6, p<0.0001), and 80% of the patients were free from cardiac events. Cox multivariate analysis identified EF <25% as a risk factor for recurrence of moderate (2) MR.
Conclusions: We found that RMA for IMR patients with LV dysfunction restored leaflet coaptation and LV geometry and functions, which were maintained in most patients even at 3 years after surgery.