Combined CABG and restrictive annuloplasty in patients with ischemic mitral regurgitation significantly reduced LV end-systolic dimension from 51 to 43 mm (P<0.001) at 2 years.
Observational (n=51)
Does combined CABG and restrictive annuloplasty improve left ventricular reverse remodeling and clinical outcomes in patients with ischemic cardiomyopathy and severe mitral regurgitation?
Combined restrictive annuloplasty and CABG in patients with ischemic cardiomyopathy and severe mitral regurgitation leads to significant left ventricular reverse remodeling and symptomatic improvement at 2 years.
valor p: p=<0.001
BACKGROUND: Data on combined coronary artery bypass grafting (CABG) and restrictive annuloplasty in patients with ischemic cardiomyopathy are scarce, and the effect on reverse left ventricular (LV) remodeling is unknown. METHODS AND RESULTS: 51 patients with ischemic LV dysfunction (LV ejection fraction 31+/-8%) and severe mitral regurgitation (grade 3 to 4+) underwent CABG and restrictive annuloplasty with stringent downsizing of the mitral annulus (by 2 sizes, Physio-ring, mean size 28+/-2). Serial transthoracic echocardiographic studies were performed (before surgery and within 3 months and 1.5 years after surgery) to assess mitral regurgitation, transmitral gradient, leaflet coaptation, and left atrial and LV reverse remodeling. Clinical follow-up (New York Heart Association NYHA class, survival, events) was assessed at 2-year follow-up. Early operative mortality was 5.6%; at 2-year follow-up, all patients were free of endocarditis and thromboembolism, and 1 needed re-operation for recurrent mitral regurgitation; 2-year survival was 84%. NYHA class improved from 3.4+/-0.8 to 1.3+/-0.4 (P<0.01), with all patients in class I/II. Intraoperative transesophageal echo showed minimal (grade 1+) mitral regurgitation in 8 patients and none in 43, without stenosis. Leaflet coaptation was 0.8+/-0.2 cm. These values remained unchanged; all patients had no or minimal (grade 1+) mitral regurgitation at 2-year follow-up. LV end-systolic and end-diastolic dimensions decreased from 51+/-10 to 43+/-12 mm (P<0.001) and from 64+/-8 to 58+/-11 mm (P<0.001). Left atrial dimension decreased from 53+/-8 to 47+/-7 mm (P<0.001). CONCLUSIONS: Excellent results of combined restrictive annuloplasty and CABG were obtained. Residual mitral regurgitation was absent/minimal at 2-year follow-up, associated with a significant reduction in left atrial dimension and LV reverse remodeling.
Bax et al. (Mon,) conducted a observational in Ischemic cardiomyopathy with severe mitral regurgitation (n=51). CABG and restrictive annuloplasty was evaluated on LV end-systolic dimension (mm) (p=<0.001). Combined CABG and restrictive annuloplasty in patients with ischemic mitral regurgitation significantly reduced LV end-systolic dimension from 51 to 43 mm (P<0.001) at 2 years.
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