Key result
Restrictive mitral annuloplasty with surgical ventricular restoration reduced LV end-diastolic and end-systolic volume indexes by 35% and 42%, compared to 21% and 27% with RMA alone.
Why the study?
Does the addition of surgical ventricular restoration to restrictive mitral annuloplasty improve left ventricular reverse remodeling in patients with ischemic cardiomyopathy and severe mitral regurgitation?
Cohort (n=39)
Does the addition of surgical ventricular restoration to restrictive mitral annuloplasty improve left ventricular reverse remodeling in patients with ischemic cardiomyopathy and severe mitral regurgitation?
Absolute Event Rate: 35% vs 21%
In patients with ischemic cardiomyopathy and severe mitral regurgitation, adding surgical ventricular restoration to restrictive mitral annuloplasty results in greater reductions in left ventricular volumes, suggesting enhanced reverse remodeling.
Greater LV volume reductions with added surgical ventricular restoration; hypothesis-generating for reverse remodeling and requires randomized confirmation.
BACKGROUND: We assessed changes in left ventricular (LV) volume and function and in regional myocardial wall stress in noninfarcted segments after restrictive mitral annuloplasty (RMA) with or without surgical ventricular restoration (SVR). METHODS AND RESULTS: Thirty-nine patients with ischemic cardiomyopathy (ejection fraction ≤ 0.35) and severe mitral regurgitation (≥ 3) were studied before and 2.8 months after surgery with cine-angiographic multidetector computed tomography (cine-MDCT). Eighteen underwent RMA alone (RMA group) and 21 underwent RMA and SVR (RMA+SVR group). In addition to measuring conventional parameters (LV end-diastolic volume index [LVEDVI], LV end-systolic volume index [LVESVI], and LV ejection fraction), we evaluated the regional circumferential end-systolic wall stress and mean circumferential fiber shortening in both the basal and mid-LV regions using 3-dimensional cine-MDCT images. LV end-diastolic and end-systolic volume indexes were significantly greater in the RMA+SVR group than in the RMA group preoperatively, but these values did not differ significantly postoperatively. LV end-diastolic and end-systolic volume indexes decreased significantly, by 21% and 27% after RMA and by 35% and 42% after RMA and SVR, and the percent reductions in LV end-diastolic and end-systolic volume indexes were significantly larger in the RMA+SVR group. Regional end-systolic wall stress decreased and circumferential fiber shortening increased significantly in the noninfarcted regions after RMA with or without SVR. CONCLUSIONS: RMA plus SVR showed a potentially greater reduction of LV end-diastolic and end-systolic volume indexes than RMA alone. In selected patients with more advanced LV remodeling, concomitant SVR may favorably affect the LV reverse-remodeling process induced by RMA.
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Shudo et al. (2011) conducted a cohort in Ischemic cardiomyopathy with severe mitral regurgitation (n=39). Restrictive mitral annuloplasty (RMA) with surgical ventricular restoration (SVR) vs. Restrictive mitral annuloplasty (RMA) alone was evaluated on Percent reduction in LV end-diastolic volume index. Restrictive mitral annuloplasty with surgical ventricular restoration reduced LV end-diastolic and end-systolic volume indexes by 35% and 42%, compared to 21% and 27% with RMA alone.
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