Long-term results of mitral repair for functional mitral regurgitation in idiopathic dilated cardiomyopathy

Michele De Bonis, Maurizio Taramasso, Alessandro Verzini, David Ferrara, Elisabetta Lapenna, Maria Chiara Calabrese, Antonio Grimaldi, Ottavio Alfieri

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objectives: While the results of mitral repair in ischaemic mitral regurgitation have been repeatedly reported, less data are available about the outcome of surgical repair of functional mitral regurgitation (FMR) in idiopathic dilated cardiomyopathy (iDCM) which represents the topic of this study. Methods: Fifty-four iDCM patients (mean age 63 ± 10.5 years) underwent mitral valve repair for severe FMR. Coronary angiography confirmed the absence of coronary disease in all patients. Most of the patients (77.7%) were in New York Heart Association (NYHA) class III-IV. Pre-operative ejection fraction (EF) was 30.4 ± 8.5%, left ventricle end-diastolic diameter (LVEDD) 67.5 ± 7.8mm, left ventricle end-systolic diameter (LVESD) diameter 53.9 ± 8.3mm. Concomitant procedures were atrial fibrillation (AF) ablation (19 patients) and tricuspid repair (17 patients). Follow-up was 100% complete (mean 4.2± 2.5 years, median 4.2 years, range 3.3 months-11.1 years). Results: In-hospital mortality was 5.6%. Actuarial survival at 6.5 years was 69± 8.8%. Patients submitted to successful AF ablation and/ or cardiac resynchronization therapy (CRT) had a significantly better survival (91 ± 7.9 vs 67 ± 9.5%, P= 0.01). Freedom from MR≥3+/4+ was 89.1 ± 5.7% at 6.5 years. Follow-up echocardiography showed a reduction in LVEDD (P<0.0001) and LVESD (P= 0.0003). Mean EF increased to 38.7± 12.4% (P<0.0001). Multivariate analysis identified successful ablation of AF and/or CRT (P= 0.01) and higher preoperative EF (0.03) as predictors of overall survival. Successful ablation of AF and/or CRT (P= 0.02) and lower preoperative systolic pulmonary artery pressure (0.04) were identified as independent predictors of reverse LV remodelling at follow-up. At last follow-up, 86.2% of the patients were in NYHA II or less. Conclusions: Mitral repair for FMR in well-selected iDCM patients is associated with low hospital mortality and significant clinical benefit at late follow-up. Concomitant successful AF ablation and/or CRT provide a major symptomatic and prognostic advantage and should be associated to mitral surgery whenever indicated.

Original languageEnglish
Article numberezs078
Pages (from-to)640-646
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume42
Issue number4
DOIs
Publication statusPublished - Oct 2012

Fingerprint

Dilated Cardiomyopathy
Mitral Valve Insufficiency
Cardiac Resynchronization Therapy
Atrial Fibrillation
Heart Ventricles
Hospital Mortality
Survival
Coronary Angiography
Mitral Valve
Pulmonary Artery
Coronary Disease
Echocardiography
Multivariate Analysis
Pressure

Keywords

  • Dilated cardiomyopathy
  • Functional mitral regurgitation
  • Mitral valve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Long-term results of mitral repair for functional mitral regurgitation in idiopathic dilated cardiomyopathy. / De Bonis, Michele; Taramasso, Maurizio; Verzini, Alessandro; Ferrara, David; Lapenna, Elisabetta; Calabrese, Maria Chiara; Grimaldi, Antonio; Alfieri, Ottavio.

In: European Journal of Cardio-thoracic Surgery, Vol. 42, No. 4, ezs078, 10.2012, p. 640-646.

Research output: Contribution to journalArticle

De Bonis, Michele ; Taramasso, Maurizio ; Verzini, Alessandro ; Ferrara, David ; Lapenna, Elisabetta ; Calabrese, Maria Chiara ; Grimaldi, Antonio ; Alfieri, Ottavio. / Long-term results of mitral repair for functional mitral regurgitation in idiopathic dilated cardiomyopathy. In: European Journal of Cardio-thoracic Surgery. 2012 ; Vol. 42, No. 4. pp. 640-646.
@article{eac5291a89a242a1a927903cc3b7ad1c,
title = "Long-term results of mitral repair for functional mitral regurgitation in idiopathic dilated cardiomyopathy",
abstract = "Objectives: While the results of mitral repair in ischaemic mitral regurgitation have been repeatedly reported, less data are available about the outcome of surgical repair of functional mitral regurgitation (FMR) in idiopathic dilated cardiomyopathy (iDCM) which represents the topic of this study. Methods: Fifty-four iDCM patients (mean age 63 ± 10.5 years) underwent mitral valve repair for severe FMR. Coronary angiography confirmed the absence of coronary disease in all patients. Most of the patients (77.7{\%}) were in New York Heart Association (NYHA) class III-IV. Pre-operative ejection fraction (EF) was 30.4 ± 8.5{\%}, left ventricle end-diastolic diameter (LVEDD) 67.5 ± 7.8mm, left ventricle end-systolic diameter (LVESD) diameter 53.9 ± 8.3mm. Concomitant procedures were atrial fibrillation (AF) ablation (19 patients) and tricuspid repair (17 patients). Follow-up was 100{\%} complete (mean 4.2± 2.5 years, median 4.2 years, range 3.3 months-11.1 years). Results: In-hospital mortality was 5.6{\%}. Actuarial survival at 6.5 years was 69± 8.8{\%}. Patients submitted to successful AF ablation and/ or cardiac resynchronization therapy (CRT) had a significantly better survival (91 ± 7.9 vs 67 ± 9.5{\%}, P= 0.01). Freedom from MR≥3+/4+ was 89.1 ± 5.7{\%} at 6.5 years. Follow-up echocardiography showed a reduction in LVEDD (P<0.0001) and LVESD (P= 0.0003). Mean EF increased to 38.7± 12.4{\%} (P<0.0001). Multivariate analysis identified successful ablation of AF and/or CRT (P= 0.01) and higher preoperative EF (0.03) as predictors of overall survival. Successful ablation of AF and/or CRT (P= 0.02) and lower preoperative systolic pulmonary artery pressure (0.04) were identified as independent predictors of reverse LV remodelling at follow-up. At last follow-up, 86.2{\%} of the patients were in NYHA II or less. Conclusions: Mitral repair for FMR in well-selected iDCM patients is associated with low hospital mortality and significant clinical benefit at late follow-up. Concomitant successful AF ablation and/or CRT provide a major symptomatic and prognostic advantage and should be associated to mitral surgery whenever indicated.",
keywords = "Dilated cardiomyopathy, Functional mitral regurgitation, Mitral valve",
author = "{De Bonis}, Michele and Maurizio Taramasso and Alessandro Verzini and David Ferrara and Elisabetta Lapenna and Calabrese, {Maria Chiara} and Antonio Grimaldi and Ottavio Alfieri",
year = "2012",
month = "10",
doi = "10.1093/ejcts/ezs078",
language = "English",
volume = "42",
pages = "640--646",
journal = "European Journal of Cardio-thoracic Surgery",
issn = "1010-7940",
publisher = "European Association for Cardio-Thoracic Surgery",
number = "4",

}

TY - JOUR

T1 - Long-term results of mitral repair for functional mitral regurgitation in idiopathic dilated cardiomyopathy

AU - De Bonis, Michele

AU - Taramasso, Maurizio

AU - Verzini, Alessandro

AU - Ferrara, David

AU - Lapenna, Elisabetta

AU - Calabrese, Maria Chiara

AU - Grimaldi, Antonio

AU - Alfieri, Ottavio

PY - 2012/10

Y1 - 2012/10

N2 - Objectives: While the results of mitral repair in ischaemic mitral regurgitation have been repeatedly reported, less data are available about the outcome of surgical repair of functional mitral regurgitation (FMR) in idiopathic dilated cardiomyopathy (iDCM) which represents the topic of this study. Methods: Fifty-four iDCM patients (mean age 63 ± 10.5 years) underwent mitral valve repair for severe FMR. Coronary angiography confirmed the absence of coronary disease in all patients. Most of the patients (77.7%) were in New York Heart Association (NYHA) class III-IV. Pre-operative ejection fraction (EF) was 30.4 ± 8.5%, left ventricle end-diastolic diameter (LVEDD) 67.5 ± 7.8mm, left ventricle end-systolic diameter (LVESD) diameter 53.9 ± 8.3mm. Concomitant procedures were atrial fibrillation (AF) ablation (19 patients) and tricuspid repair (17 patients). Follow-up was 100% complete (mean 4.2± 2.5 years, median 4.2 years, range 3.3 months-11.1 years). Results: In-hospital mortality was 5.6%. Actuarial survival at 6.5 years was 69± 8.8%. Patients submitted to successful AF ablation and/ or cardiac resynchronization therapy (CRT) had a significantly better survival (91 ± 7.9 vs 67 ± 9.5%, P= 0.01). Freedom from MR≥3+/4+ was 89.1 ± 5.7% at 6.5 years. Follow-up echocardiography showed a reduction in LVEDD (P<0.0001) and LVESD (P= 0.0003). Mean EF increased to 38.7± 12.4% (P<0.0001). Multivariate analysis identified successful ablation of AF and/or CRT (P= 0.01) and higher preoperative EF (0.03) as predictors of overall survival. Successful ablation of AF and/or CRT (P= 0.02) and lower preoperative systolic pulmonary artery pressure (0.04) were identified as independent predictors of reverse LV remodelling at follow-up. At last follow-up, 86.2% of the patients were in NYHA II or less. Conclusions: Mitral repair for FMR in well-selected iDCM patients is associated with low hospital mortality and significant clinical benefit at late follow-up. Concomitant successful AF ablation and/or CRT provide a major symptomatic and prognostic advantage and should be associated to mitral surgery whenever indicated.

AB - Objectives: While the results of mitral repair in ischaemic mitral regurgitation have been repeatedly reported, less data are available about the outcome of surgical repair of functional mitral regurgitation (FMR) in idiopathic dilated cardiomyopathy (iDCM) which represents the topic of this study. Methods: Fifty-four iDCM patients (mean age 63 ± 10.5 years) underwent mitral valve repair for severe FMR. Coronary angiography confirmed the absence of coronary disease in all patients. Most of the patients (77.7%) were in New York Heart Association (NYHA) class III-IV. Pre-operative ejection fraction (EF) was 30.4 ± 8.5%, left ventricle end-diastolic diameter (LVEDD) 67.5 ± 7.8mm, left ventricle end-systolic diameter (LVESD) diameter 53.9 ± 8.3mm. Concomitant procedures were atrial fibrillation (AF) ablation (19 patients) and tricuspid repair (17 patients). Follow-up was 100% complete (mean 4.2± 2.5 years, median 4.2 years, range 3.3 months-11.1 years). Results: In-hospital mortality was 5.6%. Actuarial survival at 6.5 years was 69± 8.8%. Patients submitted to successful AF ablation and/ or cardiac resynchronization therapy (CRT) had a significantly better survival (91 ± 7.9 vs 67 ± 9.5%, P= 0.01). Freedom from MR≥3+/4+ was 89.1 ± 5.7% at 6.5 years. Follow-up echocardiography showed a reduction in LVEDD (P<0.0001) and LVESD (P= 0.0003). Mean EF increased to 38.7± 12.4% (P<0.0001). Multivariate analysis identified successful ablation of AF and/or CRT (P= 0.01) and higher preoperative EF (0.03) as predictors of overall survival. Successful ablation of AF and/or CRT (P= 0.02) and lower preoperative systolic pulmonary artery pressure (0.04) were identified as independent predictors of reverse LV remodelling at follow-up. At last follow-up, 86.2% of the patients were in NYHA II or less. Conclusions: Mitral repair for FMR in well-selected iDCM patients is associated with low hospital mortality and significant clinical benefit at late follow-up. Concomitant successful AF ablation and/or CRT provide a major symptomatic and prognostic advantage and should be associated to mitral surgery whenever indicated.

KW - Dilated cardiomyopathy

KW - Functional mitral regurgitation

KW - Mitral valve

UR - http://www.scopus.com/inward/record.url?scp=84861508401&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861508401&partnerID=8YFLogxK

U2 - 10.1093/ejcts/ezs078

DO - 10.1093/ejcts/ezs078

M3 - Article

C2 - 22447810

AN - SCOPUS:84861508401

VL - 42

SP - 640

EP - 646

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

SN - 1010-7940

IS - 4

M1 - ezs078

ER -