Original article
Cardiovascular
A Prospective Study of Predicting Factors in Ischemic Mitral Regurgitation Recurrence After Ring Annuloplasty

https://doi.org/10.1016/j.athoracsur.2007.04.106Get rights and content

Background

Ischemic mitral regurgitation (IMR) is a complex lesion to repair, and its successful management requires an understanding of its mechanism and severity. Ring annuloplasty, currently the surgical treatment of choice for IMR, has failure rates as high as 30% in patients with functional IMR. We sought to study the variables that can predict IMR recurrence after ring annuloplasty.

Methods

This is a prospective study of 114 patients with 3+ to 4+ IMR who underwent coronary artery bypass grafting and mitral valve annuloplasty with acceptable results at an approximately 2-year follow-up. Variables were compared in a failure group, comprising patients with 2+ or higher MR and a nonfailure group, consisting of those with less than +2 MR.

Results

There were five postoperative in-hospital deaths. During follow-up, 14 patients died and 95 patients were evaluated. After a mean follow-up of 22.2 ± 4.6 months for the nonfailure group and 18.6 ± 5.6 months for the failure group, 23 patients (24.4%) exhibited annuloplasty failure. Some variables had an effect in our univariate analysis, but only interpapillary muscle distance had a relationship with recurrent MR in the multivariate analysis. Mean preoperative interpapillary muscle distance was 15.0 ± 4.0 and 26.5 ± 2.9 in the nonfailure group and failure group, respectively (p < 0.0001).

Conclusions

Interpapillary muscle distance, as a reliable index of dysfunctional subvalvular apparatus in patients with IMR, can predict late postrepair MR and indicate the need for a procedure complementary to annuloplasty.

Section snippets

Patient Population

Between May 2002 and March 2004, 1617 patients were referred to Day General Hospital for elective first-time coronary artery bypass grafting (CABG). After quantitative echocardiographic measurements, 121 patients with chronic 3+ and 4+ IMR on a scale of 1 to 4, as judged by a consensus of 2 observers, underwent coronary angiography, followed by CABG and mitral annuloplasty. All the patients had had a MI at least 6 weeks previously.

The patients were evaluated with intraoperative

Results

There were 5 postoperative in-hospital deaths. During follow-up, 14 patients died: 12 of cardiac causes (heart failure in 7, sudden death in 3, acute ischemia in 2) and 2 of noncardiac causes (accident in 1, leukemia in 1). Analysis was done on 95 patients.

The mean age of the patients was 54.6 ± 11.3 years and 74 (77.9%) were men. MR was at grade 3 in 29 patients (30.5%) and at grade 4 in 66 (69.5%). The subjects had a mean iPMD of 17.3 ± 6.0 mm, annular size of 38.3 ± 3.1 mm, coaptation depth

Comment

Indubitably, further research is required to help improve the prognosis of patients with IMR. As mentioned earlier, mitral annuloplasty is the surgical treatment of choice for patients with IMR. In the current study, 24.2% of the patients, who had successful mitral annuloplasty, showed MR recurrence (2+ or more) within 22.35 months of follow-up, an incidence almost similar to that described by other investigators [3, 4, 5]. Because annuloplasty has a considerable rate of failure and mitral

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