J Korean Med Sci.  2011 Dec;26(12):1582-1590. 10.3346/jkms.2011.26.12.1582.

Long-Term Echocardiographic Follow-up after Posterior Mitral Annuloplasty Using a Vascular Strip for Ischemic Mitral Regurgitation: Ten-Years of Experience at a Single Center

• Jeong DS
• Lee HY
• Kim WS
• Sung K
• Jun TG
• Yang JH
• Park PW
• Lee YT

• KMID: 1786014
• DOI: http://doi.org/10.3346/jkms.2011.26.12.1582

Abstract

Management of ischemic mitral regurgitation (MR) is challenging. The aim of this study was to investigate long-term clinical and echocardiographic results of restrictive mitral annuloplasty for ischemic MR. From 2001 through 2010, 96 patients who underwent myocardial revascularization with restrictive mitral annuloplasty using a vascular strip for ischemic MR were analyzed. Patients were stratified into two groups based on left ventricular ejection fraction (LVEF): group I, n = 50, with LVEF > 35% and group II, n = 46, with LVEF < or = 35%. The early mortality rate was 2.1% (2/96) and the late cardiac mortality rate was 11.5% (11/96). MR grade was reduced at discharge (0.8 +/- 0.7) but increased during follow-up (1.1 +/- 0.8, P = 0.001). There was no intergroup difference in terms of freedom from recurrent MR > or = moderate eight years after surgery (94.1% +/- 5.7%, group I vs 87.8% +/- 7.2%, group II; P = 0.575). NYHA functional class (odds ratio [OR], 2.2; P = 0.044) and early postoperative residual MR > or = mild (OR, 25.4; P < 0.001) were independent predictors of recurrent MR. Restrictive mitral annuloplasty using a vascular strip is effective in ischemic MR. It is important to avoid early postoperative residual MR.

Keyword

Coronary Artery Disease; Myocardial Ischemia; Mitral Valve Iinsufficiency; Myocardial Revascularization; Mitral Valve Annuloplasty

MeSH Terms

Aged
Aged, 80 and over
Coronary Artery Disease/mortality/*surgery
Echocardiography
Female
Follow-Up Studies
Heart Valve Prosthesis Implantation
Humans
Male
Middle Aged
Mitral Valve/physiopathology/*surgery
Mitral Valve Annuloplasty/*methods
Mitral Valve Insufficiency/mortality/*surgery
Myocardial Ischemia/mortality/*surgery
Myocardial Revascularization
Stroke Volume
Treatment Outcome
Vascular Surgical Procedures

Figure

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  Fig. 1 Competent mitral valve repair after posterior annuloplasty using a vascular strip.

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  Fig. 2 Kaplan-Meier estimates for survival and recurrence of mitral regurgitation. (A) Freedom from cardiac-related mortality. LVEF, left ventricular ejection fraction. (B) Freedom from presence of mild or greater mitral regurgitation (MR). (C) Freedom from presence of moderate or greater mitral regurgitation. (D) Freedom from presence of increased mitral regurgitation.

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  Fig. 3 Serial changes of mitral regurgitation severity during follow-up.

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  Fig. 4 Changes in echocardiographic parameters of left ventricular diastolic function. Early filling peak velocity (E); LVEF, left ventricular ejection fraction. (B) Ratio (E/A) of early filling peak velocity to atrial peak velocity. (C) Ratio between early diastolic mitral inflow and mitral annulus velocity (E'/e). (D) Deceleration time (DT) of mitral inflow.

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