Muath Bishawi1, Moritz C. Wyler von Ballmoos1, Carmelo Milano1, Jeffrey Gaca1, Madhav Swaminathan2, Alina Nicoara2, Donald D. Glower1,31Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham NC, USA
2Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham NC, USA
3Electronic correspondence: email@example.com
Background and aim of the study: The optimal treatment for ischemic mitral regurgitation (IMR) continues to be controversial. Recent data have demonstrated high rates of recurrent mitral regurgitation (MR) at one and two years in patients who undergo mitral valve repair. The study aim was to examine the durability of valve repair for IMR at an experienced high-volume repair center, using undersized, rigid annuloplasty rings.
Methods: Consecutive patients with severe IMR were evaluated from a prospectively maintained database. All patients undergoing a repair with or without coronary revascularization were included. Follow up echocardiography was performed locally and at referring centers.
Results: A total of 147 patients (86 males, 61 females) met the study inclusion criteria. Preoperative echocardiography showed that 47 patients (32%) had moderate-severe MR, and 100 (68%) had severe MR.
Concomitant coronary re-vascularization was performed in 117 patients (80%). In all patients, the valve repair was made using a rigid or semi-rigid annuloplasty ring. The most common ring size was 24 mm (inserted in 41% of cases), followed by 26 mm (inserted in 35%). Twelve patients (8.1% [4.2-13.8%]) developed recurrent severe MR during a total 656 patient-years (pt-yr) of follow up (incidence 18.2 [9.4-31.9] per 1000 pt-yr). The incidence of recurrent severe MR at one, five and 10 years was 2.8% [0.9%-6.7%], 6.8% [3.3-11.9%], 7.9 [4.0-13.6%], respectively, and for moderate MR was 14.8% [9.5-21.2%], 28.7% [21.3-36.5%] and 35.8% [27.4-44.2%], respectively.
Conclusion: In selected patients, mitral valve repair for severe IMR can be associated with excellent freedom from moderate MR up to five years when performed with an undersized, rigid annuloplasty ring with appropriate coronary artery bypass grafting.
The Journal of Heart Valve Disease 2018-19;27:285-292
|Durability of Ischemic Mitral Repair in Patients Treated with a Rigid, Undersized Annuloplasty Ring|
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