Additional submitral and ventricular procedures for severe ischemic mitral regurgitation yielded a 3-year cardiac-related survival rate of 89%, comparable to annuloplasty alone for mild disease.
Cohort (n=90)
No
Does a tailored surgical strategy adding submitral and ventricular procedures to annuloplasty improve outcomes in patients with ischemic mitral regurgitation and severe LV remodeling?
Absolute Event Rate: 89% vs 89%
p-value: p=0.92
PURPOSE: The progression of left ventricular (LV) remodeling and subsequent mitral valve tethering impair the results of reduction annuloplasty for ischemic mitral regurgitation (MR). METHODS: We studied 90 patients who underwent surgical repair of ischemic MR between 1999 and 2013 according to our surgical strategy adding submitral and ventricular procedures to annuloplasty as follows: annuloplasty alone (stage 1, n = 30), additional papillary muscle approximation (PMA) for progression of tethering (stage 2, n = 26), and additional left ventriculoplasty with PMA for progression of LV remodeling and tethering (stage 3, n = 34). RESULTS: The preoperative New York Heart Association (NYHA) functional classes (2.5 ± 0.7, 3.1 ± 0.7 and 3.3 ± 0.7 for stages 1, 2 and 3, respectively, P <0.001), LV end-diastolic diameters (56 ± 7 mm, 66 ± 5 mm and 70 ± 7 mm, P <0.001), and LV ejection fractions (45 ± 12%, 32 ± 9% and 27 ± 9%, P <0.001) significantly differed among the stages. In contrast, the MR grades did not significantly differ (2.9 ± 0.8, 3.0 ± 1.0, and 2.9 ± 1.1, respectively; P = 0.93). Both the rates of cardiac-related survival and freedom from reoperation were comparable among the 3 groups (log-rank P = 0.92 and 0.58, respectively). CONCLUSION: Additional submitral and ventricular procedures can compensate for the possible impairment of the outcomes after annuloplasty alone for ischemic MR in patients with severe LV remodeling and tethering.
Wakasa et al. (Thu,) conducted a cohort in Ischemic mitral regurgitation (n=90). Additional submitral and ventricular procedures (papillary muscle approximation and left ventriculoplasty) vs. Annuloplasty alone was evaluated on 3-year cardiac-related survival (p=0.92). Additional submitral and ventricular procedures for severe ischemic mitral regurgitation yielded a 3-year cardiac-related survival rate of 89%, comparable to annuloplasty alone for mild disease.