Introduction : Mitral regurgitation (MR) resulting from ischemia and / or dilated cardiomyopathy carries a poor prognosis if not properly treated. We hypothesized that restrictive (undersized) annuloplasty cures MR which improves left ventricular function and patients' functional status.
Methods : Between January 2000 and January 2002, 35 patients underwent restrictive mitral annuloplasty (RMA). Twenty-seven patients had posterior wall ischemia (PWI) and were scheduled for CABG, 8 patients had dilating cardiomyopathy (DCMP). Mean age was 65 years (range: 33 - 77 years). All patients underwent undersized (i.e. two ring sizes) mitral annuloplasty: mean annulus: 31.4 mm, mean ring: 27.5 mm. In the ischemic group all patients underwent CABG (mean 2.5 anastomoses). Additional tricuspid valvuloplasty was performed in six patients.
Results : In-hospital mortality for the ischemic group was 3 out of 27; for the DCMP group it was 1 out of 8. Mean duration of follow-up was 13 months. There were two late deaths (one in each group).
Echocardiographic results at a follow-up of 8 months:
|
All patients |
|
PWI |
|
DCMP |
| |
|
Pre-op |
Current |
Pre-op |
Current |
Pre-op |
Current | |
| Mean NYHA |
3.3 |
1.2 |
3.3 |
1.2 |
3.5 |
1.0 |
| LVEDD (mm) |
62 |
58 |
60 |
56 |
78 |
74 |
|
Mean MR |
3.3 |
0.4 |
3.3 |
0.4 |
3.5 |
0. |
LVEDD : left ventricular end-diastolic dimension
Conclusion : RMA treats MR with equal success in dilated cardiomyopathy and in ischemia. At mid-term follow-up, LV diameter decreases, freedom from MR persists and functional status improves.