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December 22, 2010Circulation JournalOpen Access

Restrictive Mitral Annuloplasty for Functional Mitral Regurgitation - Acute Hemodynamics and Serial Echocardiography -

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Key result

Restrictive mitral annuloplasty for functional mitral regurgitation resulted in sustained improvement of hemodynamics and left ventricular function, while preoperative severe pulmonary hypertension strongly predicted postoperative adverse cardiac events (HR 6.8).

Population

44 patients with refractory heart failure and functional mitral regurgitation, mean age 62±9 years, 75%…

Design

Cohort, Echocardiography examiner was blinded to the clinical status of the…

Follow-up

mean 48±33 months

Authors

SKSatoshi KainumaNational Cerebral and Cardiovascular CenterKTKazuhiro TaniguchiYasuda Women's UniversityKTKöichi TodaSaitama International Medical Center

Discussion

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Implication

Supports further evaluation of restrictive mitral annuloplasty in functional MR; leaves open randomized confirmation of durability and pulmonary hypertension risk stratification.

Study Design

Type

Cohort (n=44)

Multicenter

No

Structured PICO

P
Population
44 patients with refractory heart failure, advanced cardiomyopathy, and functional mitral regurgitation who underwent restrictive mitral annuloplasty, followed for a mean of 48 months.
I
Intervention
Restrictive mitral annuloplasty (RMA) with stringent downsizing of the mitral annulus (by 2-4 ring sizes) using Cosgrove-Edwards or Carpentier-Edwards Physio ring.
O
Outcome
Acute hemodynamic changes (via cardiac catheterization at 1 month) and serial echocardiographic changes in left ventricular function, systolic pulmonary artery pressure, and mitral valve geometry.surrogate

Main Result

Hazard Ratio: 6.8 (95% CI 1.1–41.9)

p-value: p=0.04

Restrictive mitral annuloplasty in patients with advanced cardiomyopathy and functional mitral regurgitation provides sustained improvements in hemodynamics and left ventricular function, though preoperative severe pulmonary hypertension predicts worse outcomes.

Limitations

  • Retrospective study design
  • Small sample size
  • Exclusion of patients with less LV remodeling and ischemic MR due to predominant inferior/posterior myocardial infarction
  • Inclusion of patients with different etiologies of cardiomyopathy and concomitant surgical procedures (e.g., surgical ventricular reconstruction)
  • Use of semiquantitative measurement for MR severity rather than quantitative grading
  • Lack of an untreated control group
  • Retrospective nature
  • Small number of subjects
  • Inclusion of patients with different etiologies of cardiomyopathy and concomitant surgical procedures
  • Semiquantitative grading of MR severity

Cite This Study

Kainuma et al. (2010) conducted a cohort in Functional mitral regurgitation and advanced cardiomyopathy (n=44). Restrictive mitral annuloplasty vs. Baseline was evaluated on Postoperative adverse cardiac events (predicted by preoperative severe pulmonary hypertension, systolic PAP >60 mmHg) (HR 6.8, 95% CI 1.1-41.9, p=0.04). Restrictive mitral annuloplasty for functional mitral regurgitation resulted in sustained improvement of hemodynamics and left ventricular function, while preoperative severe pulmonary hypertension strongly predicted postoperative adverse cardiac events (HR 6.8).

synapsesocial.com/papers/6a96f3b033d7b00ae7bba943https://doi.org/10.1253/circj.cj-10-0759

Topics

Mitral valve interventionHeart failureHFrEF treatment
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Also Consider

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

  1. 1Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in ischemic mitral regurgitation☆2005 · 247 citations
  2. 2Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction2005 · 713 citations
  3. 3Isolated Undersized Mitral Annuloplasty for Functional Mitral Regurgitation in Non-Ischemic Dilated Cardiomyopathy Reconsideration of the Relationship Between Preoperative Coaptation Depth and Persistent Mitral Regurgitation2008 · 6 citations
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