Left Ventricular Reverse Remodeling After Undersized Mitral Ring Annuloplasty in Patients With Ischemic Regurgitation

Sandro Gelsomino, Roberto Lorusso, Irene Capecchi, Carlo Rostagno, Stefano Romagnoli, Giuseppe Billè, Giuseppe De Cicco, Cecilia Tetta, Pierluigi Stefàno, Gian Franco Gensini

Research output: Contribution to journalArticle

Abstract

Background: Long-term durability of combined coronary artery bypass grafting and of undersized mitral ring annuloplasty (UMRA) is uncertain. A considerable number of patients show recurrent regurgitation. This study examines the difference in the benefit of UMRA on clinical end points and recurrence of mitral regurgitation between responders and nonresponders of left ventricular reverse remodeling. Methods: Study eligibility criteria were fulfilled by 204 patients with chronic ischemic mitral regurgitation (CIMR) who survived combined coronary artery bypass grafting and reductive annuloplasty between September 2001 and September 2006. Patients underwent echocardiography preoperatively, at discharge, and at follow-up appointments (100% complete). Median early follow-up was 6 months (interquartile range [IRQ], 3 to 8 months; late follow-up, 35 months (IRQ, 21 to 50 months). Reverse remodeling was considered a reduction in left ventricular end systolic volume index exceeding 15%. Results: There were 84 responders (41.2%) of reverse remodeling (age, 68 ± 7.4 years; 51 men) and 120 nonresponders (58.8%; age, 67 ± 7.6 years; 78 men). Nonresponders had a higher recurrence of mitral regurgitation (p <0.001), higher reoperation rate for failed repair (p <0.001), and significantly larger left ventricular volumes and dimension at any study point (p <0.001), with significant late increase of sphericity indexes exceeding preoperative values (p <0.001). At multivariable analysis, a baseline myocardial performance index of less than 0.90 (p <0.001), a systolic sphericity index of less than 0.72 (p <0.001), and wall motion score index of less than 1.59 (p = 0.003) were independent predictors of reverse remodeling. Conclusions: Our experience suggests that more information on possible echo predictors of an inadequate result may improve preoperative decision making of CIMR patients for UMRA.

Original languageEnglish
Pages (from-to)1319-1330
Number of pages12
JournalAnnals of Thoracic Surgery
Volume85
Issue number4
DOIs
Publication statusPublished - Apr 2008

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Mitral Valve Annuloplasty
Ventricular Remodeling
Mitral Valve Insufficiency
Coronary Artery Bypass
Recurrence
Reoperation
Stroke Volume
Echocardiography
Decision Making
Appointments and Schedules

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Gelsomino, S., Lorusso, R., Capecchi, I., Rostagno, C., Romagnoli, S., Billè, G., ... Gensini, G. F. (2008). Left Ventricular Reverse Remodeling After Undersized Mitral Ring Annuloplasty in Patients With Ischemic Regurgitation. Annals of Thoracic Surgery, 85(4), 1319-1330. https://doi.org/10.1016/j.athoracsur.2007.12.074

Left Ventricular Reverse Remodeling After Undersized Mitral Ring Annuloplasty in Patients With Ischemic Regurgitation. / Gelsomino, Sandro; Lorusso, Roberto; Capecchi, Irene; Rostagno, Carlo; Romagnoli, Stefano; Billè, Giuseppe; De Cicco, Giuseppe; Tetta, Cecilia; Stefàno, Pierluigi; Gensini, Gian Franco.

In: Annals of Thoracic Surgery, Vol. 85, No. 4, 04.2008, p. 1319-1330.

Research output: Contribution to journalArticle

Gelsomino, S, Lorusso, R, Capecchi, I, Rostagno, C, Romagnoli, S, Billè, G, De Cicco, G, Tetta, C, Stefàno, P & Gensini, GF 2008, 'Left Ventricular Reverse Remodeling After Undersized Mitral Ring Annuloplasty in Patients With Ischemic Regurgitation', Annals of Thoracic Surgery, vol. 85, no. 4, pp. 1319-1330. https://doi.org/10.1016/j.athoracsur.2007.12.074
Gelsomino, Sandro ; Lorusso, Roberto ; Capecchi, Irene ; Rostagno, Carlo ; Romagnoli, Stefano ; Billè, Giuseppe ; De Cicco, Giuseppe ; Tetta, Cecilia ; Stefàno, Pierluigi ; Gensini, Gian Franco. / Left Ventricular Reverse Remodeling After Undersized Mitral Ring Annuloplasty in Patients With Ischemic Regurgitation. In: Annals of Thoracic Surgery. 2008 ; Vol. 85, No. 4. pp. 1319-1330.
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abstract = "Background: Long-term durability of combined coronary artery bypass grafting and of undersized mitral ring annuloplasty (UMRA) is uncertain. A considerable number of patients show recurrent regurgitation. This study examines the difference in the benefit of UMRA on clinical end points and recurrence of mitral regurgitation between responders and nonresponders of left ventricular reverse remodeling. Methods: Study eligibility criteria were fulfilled by 204 patients with chronic ischemic mitral regurgitation (CIMR) who survived combined coronary artery bypass grafting and reductive annuloplasty between September 2001 and September 2006. Patients underwent echocardiography preoperatively, at discharge, and at follow-up appointments (100{\%} complete). Median early follow-up was 6 months (interquartile range [IRQ], 3 to 8 months; late follow-up, 35 months (IRQ, 21 to 50 months). Reverse remodeling was considered a reduction in left ventricular end systolic volume index exceeding 15{\%}. Results: There were 84 responders (41.2{\%}) of reverse remodeling (age, 68 ± 7.4 years; 51 men) and 120 nonresponders (58.8{\%}; age, 67 ± 7.6 years; 78 men). Nonresponders had a higher recurrence of mitral regurgitation (p <0.001), higher reoperation rate for failed repair (p <0.001), and significantly larger left ventricular volumes and dimension at any study point (p <0.001), with significant late increase of sphericity indexes exceeding preoperative values (p <0.001). At multivariable analysis, a baseline myocardial performance index of less than 0.90 (p <0.001), a systolic sphericity index of less than 0.72 (p <0.001), and wall motion score index of less than 1.59 (p = 0.003) were independent predictors of reverse remodeling. Conclusions: Our experience suggests that more information on possible echo predictors of an inadequate result may improve preoperative decision making of CIMR patients for UMRA.",
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T1 - Left Ventricular Reverse Remodeling After Undersized Mitral Ring Annuloplasty in Patients With Ischemic Regurgitation

AU - Gelsomino, Sandro

AU - Lorusso, Roberto

AU - Capecchi, Irene

AU - Rostagno, Carlo

AU - Romagnoli, Stefano

AU - Billè, Giuseppe

AU - De Cicco, Giuseppe

AU - Tetta, Cecilia

AU - Stefàno, Pierluigi

AU - Gensini, Gian Franco

PY - 2008/4

Y1 - 2008/4

N2 - Background: Long-term durability of combined coronary artery bypass grafting and of undersized mitral ring annuloplasty (UMRA) is uncertain. A considerable number of patients show recurrent regurgitation. This study examines the difference in the benefit of UMRA on clinical end points and recurrence of mitral regurgitation between responders and nonresponders of left ventricular reverse remodeling. Methods: Study eligibility criteria were fulfilled by 204 patients with chronic ischemic mitral regurgitation (CIMR) who survived combined coronary artery bypass grafting and reductive annuloplasty between September 2001 and September 2006. Patients underwent echocardiography preoperatively, at discharge, and at follow-up appointments (100% complete). Median early follow-up was 6 months (interquartile range [IRQ], 3 to 8 months; late follow-up, 35 months (IRQ, 21 to 50 months). Reverse remodeling was considered a reduction in left ventricular end systolic volume index exceeding 15%. Results: There were 84 responders (41.2%) of reverse remodeling (age, 68 ± 7.4 years; 51 men) and 120 nonresponders (58.8%; age, 67 ± 7.6 years; 78 men). Nonresponders had a higher recurrence of mitral regurgitation (p <0.001), higher reoperation rate for failed repair (p <0.001), and significantly larger left ventricular volumes and dimension at any study point (p <0.001), with significant late increase of sphericity indexes exceeding preoperative values (p <0.001). At multivariable analysis, a baseline myocardial performance index of less than 0.90 (p <0.001), a systolic sphericity index of less than 0.72 (p <0.001), and wall motion score index of less than 1.59 (p = 0.003) were independent predictors of reverse remodeling. Conclusions: Our experience suggests that more information on possible echo predictors of an inadequate result may improve preoperative decision making of CIMR patients for UMRA.

AB - Background: Long-term durability of combined coronary artery bypass grafting and of undersized mitral ring annuloplasty (UMRA) is uncertain. A considerable number of patients show recurrent regurgitation. This study examines the difference in the benefit of UMRA on clinical end points and recurrence of mitral regurgitation between responders and nonresponders of left ventricular reverse remodeling. Methods: Study eligibility criteria were fulfilled by 204 patients with chronic ischemic mitral regurgitation (CIMR) who survived combined coronary artery bypass grafting and reductive annuloplasty between September 2001 and September 2006. Patients underwent echocardiography preoperatively, at discharge, and at follow-up appointments (100% complete). Median early follow-up was 6 months (interquartile range [IRQ], 3 to 8 months; late follow-up, 35 months (IRQ, 21 to 50 months). Reverse remodeling was considered a reduction in left ventricular end systolic volume index exceeding 15%. Results: There were 84 responders (41.2%) of reverse remodeling (age, 68 ± 7.4 years; 51 men) and 120 nonresponders (58.8%; age, 67 ± 7.6 years; 78 men). Nonresponders had a higher recurrence of mitral regurgitation (p <0.001), higher reoperation rate for failed repair (p <0.001), and significantly larger left ventricular volumes and dimension at any study point (p <0.001), with significant late increase of sphericity indexes exceeding preoperative values (p <0.001). At multivariable analysis, a baseline myocardial performance index of less than 0.90 (p <0.001), a systolic sphericity index of less than 0.72 (p <0.001), and wall motion score index of less than 1.59 (p = 0.003) were independent predictors of reverse remodeling. Conclusions: Our experience suggests that more information on possible echo predictors of an inadequate result may improve preoperative decision making of CIMR patients for UMRA.

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