Mid-term echocardiographic results with different rings following restrictive mitral annuloplasty for ischaemic cardiomiopathy.

Eur J Cardiothorac Surg. 2009 May 1; Onorati F, Rubino AS, Marturano D, Pasceri E, Mascaro G, Zinzi S, Serraino F, Renzulli ABackground: Despite restrictive mitral annuloplasty (RMA) being considered effective for chronic ischaemic mitral regurgitation (CIMR), few data exist on mid-term echocardiographic results with different prosthetic rings. Therefore, comparative echocardiographic analysis has been performed. Methods: Sixty-four consecutive coronary artery bypass graft surgery (CABG)+RMA (downsizing by two-ring sizes; median size: 26mm) for CIMR with a follow-up of at least 6 months were prospectively followed-up with serial echocardiograms (preoperative, discharge, 6 months, follow-up ending). Hospital mortality, follow-up clinical and echocardiographic results were analysed and compared between three groups (group A: semi-rigid band, 17 patients; group B: complete symmetric semi-rigid, 22 patients; group C: complete asymmetric semi-rigid, 25 patients). Results: Hospital mortality was 6.3%; 22.8+/-14.7 standard deviation (SD) months (range: 6-55) survival was 96.5+/-2.5%; freedom from re-intervention was 94.2+/-4.2%, from re-revascularisation 87.5+/-11.7%, from >/=grade-2 mitral regurgitation 58.2+/-9.8% and from heart failure (CHF) 71.6+/-10.5%. Recurrent (>/=grade-2) CIMR resulted in lower freedom-from-CHF (p=0.0001), worsened New York Heart Association (NYHA) classification (p=0.0001) and absence of reverse remodelling of the left ventricular end-diastolic diameter (LVEDD; p=0.004), systolic diameter (LVESD; p=0.014), indexed mass (LVMi; p=0.005) and coaptation depth (p=0.0001). Group A showed significant worse freedom from CHF (group A: 42.8+/-19.5% vs group B: 88.9+/-10.5% vs group C: 92.3+/-7.5%; p=0.049) and from recurrent CIMR (17.4+/-13.8% vs 82.1+/-11.7% vs 94.1+/-5.7%, respectively; p=0.0001). Complete rings decreased the hazard of recurrent CIMR (Physio=0.141; Adams=0.089). Higher NYHA during follow-up was found in group A (p=0.002 for group B and p=0.001 for group C) with a progressive reduction of trans-mitral mean gradient (p=0.001), and a lower degree of reverse remodelling of LVEDD (p=0.009 and p=0.010) and coaptation depth (p=0.040 and p=0.002). Conclusions: Recurrent CIMR correlates with absent ventricular reverse remodelling. Despite a higher trans-mitral gradient, complete rings achieve better results in the treatment of CIMR.