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 language | English |
|---|---|
| Article number | ezs078 |
| Pages (from-to) | 640-646 |
| Number of pages | 7 |
| Journal | European Journal of Cardio-thoracic Surgery |
| Volume | 42 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Oct 2012 |
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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 journal › Article
}
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 -