Abstract 12895: Ventricular Reshaping For Repair of Functional Mitral Regurgitation has Persistent Survival Advantage Over Traditional Annuloplasty Repair: A Single Center Analysis
Background: The RESTOR-MV trial showed improved early survival in patients with functional mitral regurgitation (FMR) requiring revascularization randomized to left ventricular reshaping device (Coapsys) compared to mitral valve reduction annuloplasty (MVRA). When the trial was prematurely terminated due to inadequate sponsor funding, 165 patients had been randomized; Coapsys had a 2 year survival advantage compared to MVRA (87% versus 77%, p=0.038, prior report). This single institution study evaluates midterm survival.
Methods: Our single center conducted midterm follow-up of RESTOR-MV patients receiving bypass surgery who were randomized to control (MVRA) or treatment (Coapsys). Chart review and social security death index analyzed survival in our 31 randomized patients. Mean follow-up was 55.8 months. Statistical comparison was made with Student's t- and Wilcoxon tests.
Results: Thirty-one patients were randomized (15 to MVRA, 16 to Coapsys). Demographics (MVRA vs. Coapsys) were: age 66.4±2.0 vs. 63.9±2.0 years, p=0.40; ejection fraction 40.9±2.6 vs. 34.6±3.7%, p=0.18; number bypass grafts 1.9±0.2 vs. 1.9±0.2, p=0.98; baseline MR grade 2.9±0.3 vs. 2.6±0.3, p=0.43; and LVED dimension 5.9±0.2 vs. 5.7±0.2 cm, p= 0.53. The 4-year survival for the MVRA and Coapsys groups were 50±14% and 74±11% (p=0.09, Wilcoxon) (Figure). At follow-up there was greater FMR reduction in the MVRA patients versus Coapsys patients (residual MR grade was 0.3±0.2 vs. 1.3±0.4, p=0.02).
Conclusions: Midterm single-center analysis indicates that patients with FMR requiring revascularization had consistently improved survival when treated with CABG and Coapsys compared to standard CABG and MVRA. Despite the modest sample size, ventricular reshaping for FMR demonstrated survival advantage at four-year follow-up. This confirms the potential value of ventricular reshaping in FMR patients and warrants further research into mechanisms of remote myocardial remodeling.
- © 2011 by American Heart Association, Inc.