Abstract 13716: Restrictive Mitral Annuloplasty with or without Surgical Ventricular Restoration in Ischemic Dilated Cardiomyopathy with Severe Mitral Regurgitation
Background: In the STICH trial, adding surgical ventricular restoration (SVR) to coronary artery bypass grafting (CABG) reduced the end-systolic volume (ESV) by 19%, vs. 6% with CABG alone. Here we assessed changes in left ventricular (LV) volume and function, and regional wall stress in non-infarcted segments, following restrictive mitral annuloplasty (RMAP) with or without SVR. Method Between 2004 and 2009, 43 patients with ischemic cardiomyopathy (ICM) (ejection fraction: EF <35%) and severe mitral regurgitation (MR) (≥3+) were studied before and 3 months after surgery using cine-angiographic multi-detector computed tomography (cine-MDCT). Twenty-two underwent RMAP alone (RMAP group) and 21 underwent RMAP and SVR (RMAP+SVR group). In addition to measuring conventional parameters (LVEDV, LVESV, and LVEF), we evaluated the regional circumferential end-systolic wall stress (ESS) and mean circumferential fiber shortening (CFS) in both the basal and mid-LV regions, using 3-dimensional cine-MDCT images.
Results: LVESV decreased by 27% in the RMAP group vs. 42% in the RMAP+SVR group. The regional ESS decreased and mean CFS increased significantly after surgery in the basal and mid-LV regions in both groups. In between-group comparisons, the two groups' mean values for the LVEDV, LVESV, LVEF, regional ESS, and mean CFS, preoperatively or postoperatively did not differ significantly, whereas the average change in the LVESV index was significantly larger in the RMAP+SVR group than the RMAP group (Table).
Conclusions: Our results from cine-MDCT showed that RMAP with or without SVR reduced LVEDV and LVESV, improved LVEF, reduced regional ESS, and improved the ejection performance of the non-infarcted myocardium in patients with ICM and MR. We found that RMAP+SVR reduced the LVESV more than RMAP alone, indicating that the surgical procedures had different effects and suggesting that some patients with advanced LV remodeling might benefit from concomitant RMAP and SVR.
- © 2010 by American Heart Association, Inc.