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April 1, 2003European Journal of Cardio-Thoracic SurgeryOpen Access

Mitral annuloplasty in patients with ischemic versus dilated cardiomyopathy

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Why the study?

Does mitral valve annuloplasty using a flexible posterior ring have comparable outcomes in patients with ischemic versus dilated cardiomyopathy with severe LV dysfunction?

Population

121 patients with severe end-stage dilated or ischemic cardiomyopathy, mitral regurgitation ≥2, and left…

Comparison

Mitral valve annuloplasty using a flexible… vs Dilated cardiomyopathy versus ischemic…

Design

Cohort

Follow-up

mean 567+/-74 days in DCM and 793+/-63 days in ICM

Authors

ZSZ SzalayKerckhoff KlinikACAli CivelekOkan UniversitySHStephen HoheSchön Klinik Vogtareuth

Discussion

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Overview

May support flexible ring annuloplasty across etiologies in severe LV dysfunction; leaves open randomized confirmation of durability.

Key Points

  • To evaluate the efficacy, survival outcomes, and risk factors of mitral valve annuloplasty using a flexible posterior ring in patients with end-stage ischemic versus dilated cardiomyopathy and severely reduced left ventricular function.
  • Retrospective comparative analysis of 121 patients with severe cardiomyopathy (30 dilated [DCM], 91 ischemic [ICM]), mitral regurgitation grade ≥2, and left ventricular ejection fraction ≤30% treated between January 1996 and July 2002.
  • All patients underwent mitral annuloplasty with a flexible posterior ring, with concomitant tricuspid repair in 46.6% of DCM vs. 12% of ICM (P=0.0001) and coronary artery bypass grafting in 10% of DCM vs. 86% of ICM (P<0.00001).
  • Patients were monitored over a mean follow-up of 567 ± 74 days for DCM and 793 ± 63 days for ICM.
  • Early operative mortality was 6.6% (8/121) across both cohorts, with late mortality occurring in 15% (17 patients) during follow-up and 2-year actuarial survival reaching 0.93 in DCM and 0.85 in ICM.
  • Symptom burden decreased equivalently after 1 year, with NYHA functional class dropping from 3.3 ± 0.1 to 1.8 ± 0.16 in DCM and from 3.2 ± 0.04 to 1.7 ± 0.07 in ICM.
  • Predictors of reconstruction failure included preoperative NYHA IV in DCM (P=0.03) and posterior infarction (P=0.025) or larger ring size (P=0.026) in ICM; predictors of death included larger ring size in DCM (P=0.02) and postoperative IABP use (P=0.002) in ICM.

Structured PICO

Does mitral valve annuloplasty using a flexible posterior ring have comparable outcomes in patients with ischemic versus dilated cardiomyopathy with severe LV dysfunction?

P
Population
121 patients with severe end-stage dilated (DCM, n=30) or ischemic cardiomyopathy (ICM, n=91), mitral regurgitation ≥2, and left ventricular ejection fraction ≤30%.
I
Intervention
Mitral valve annuloplasty using a flexible posterior ring.
C
Comparator
Dilated cardiomyopathy (DCM) versus ischemic cardiomyopathy (ICM) groups.
O
Outcome
Early mortality, NYHA class improvement at 1 year, and 2-year actuarial survival.hard clinical

Mitral annuloplasty with a flexible ring is effective and has acceptable mortality in patients with severely depressed LV function, with comparable 2-year survival between ischemic and dilated cardiomyopathy.

Cite This Study

Szalay et al. (2003) studied this question.

synapsesocial.com/papers/6a79f1b3f48aafa9d7f37403https://doi.org/10.1016/s1010-7940(02)00864-3

Topics

Mitral valve intervention
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The Hemodynamic and Prognostic Significance of Echo-Doppler-Proven Mitral Regurgitation in Patients with Dilated Cardiomyopathy2008 · 119 citations
  2. 2Determinants of end‐stage idiopathic dilated cardiomyopathy: A multivariate analysis of 104 patients1989 · 91 citations
  3. 3The effect of pathophysiology on the surgical treatment of ischemic mitral regurgitation: operative and late risks of repair versus replacement1995 · 206 citations
  4. 4Mitral valve replacement versus mitral valve repair. A Doppler and quantitative stress echocardiographic study.1994 · 99 citations
  5. 5Valvular-ventricular interaction: importance of the mitral apparatus in canine left ventricular systolic performance.1986 · 152 citations