Recurrence of Mitral Regurgitation Parallels the Absence of Left Ventricular Reverse Remodeling After Mitral Repair in Advanced Dilated Cardiomyopathy

Michele De Bonis, Elisabetta Lapenna, Alessandro Verzini, Giovanni La Canna, Antonio Grimaldi, Lucia Torracca, Francesco Maisano, Ottavio Alfieri

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Abstract

Background: The aim of this study was to assess the occurrence of reverse left ventricular (LV) remodeling after effective mitral valve repair in advanced dilated cardiomyopathy and its impact on clinical outcome and repair durability. Methods: Of 111 patients undergoing mitral valve repair in ischemic or idiopathic dilated cardiomyopathy, 79 patients with no or trivial residual mitral regurgitation (MR) at discharge and with a follow-up length of at least 6 months were included in this study. Preoperatively they had 3 to 4+ functional MR, an ejection fraction of 0.28 ± 0.055, an indexed LV end-diastolic volume of 113 ± 33.0 mL/m2, an indexed LV end-systolic volume of 80.8 ± 26.3 mL/m2, a tenting area of 2.7 ± 0.9 cm2, and a coaptation depth of 1.1 ± 0.3 cm. Sixty-three patients (79.8%) were in New York Heart Association class III or IV. A complete, rigid or semirigid undersized ring annuloplasty (with or without "edge-to-edge") was used. Concomitant procedures were coronary artery bypass grafting (49 of 79 patients, 62%), tricuspid valve repair (11 of 79 patients, 13.9%), and ablation of permanent atrial fibrillation (13 of 79 patients, 16.4%). Results: At a mean follow-up of 2 ± 1.3 years (median, 1.8 years), LV reverse remodeling was documented in 41 patients (51.8%), whereas in 38 patients (48.1%) LV dimensions remained unchanged or increased compared with preoperative values. The persistence or progression of LV remodeling paralleled the recurrence of MR and worsening of symptoms. Recurrence of MR of 3+ or greater was 0% in the "reverse remodeling" group and 18.4% in the "no reverse remodeling" one (p = 0.008). At 3 years, freedom from recurrence of MR of 2+ or greater was 74% ± 11.7% and 62% ± 9.2% (p = 0.004) and New York Heart Association class was 1.5 ± 0.61 and 2 ± 0.72 (p <0.0001), respectively. Predictors of reverse remodeling were ischemic etiology (p = 0.04), concomitant coronary artery bypass grafting (p = 0.02), successful ablation of atrial fibrillation (p = 0.05), and shorter history of congestive heart failure (p = 0.06). The use of the edge-to-edge showed a trend toward favoring reverse remodeling compared with isolated annuloplasty (p = 0.08). Conclusions: In patients with functional MR undergoing effective repair, the occurrence of reverse LV remodeling is associated with longer repair durability and a better clinical outcome compared with those with persistence or progression of the remodeling process.

Original languageEnglish
Pages (from-to)932-939
Number of pages8
JournalAnnals of Thoracic Surgery
Volume85
Issue number3
DOIs
Publication statusPublished - Mar 2008

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Ventricular Remodeling
Dilated Cardiomyopathy
Mitral Valve Insufficiency
Recurrence
Mitral Valve
Coronary Artery Bypass
Stroke Volume
Atrial Fibrillation
Tricuspid Valve
Heart Failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Recurrence of Mitral Regurgitation Parallels the Absence of Left Ventricular Reverse Remodeling After Mitral Repair in Advanced Dilated Cardiomyopathy. / De Bonis, Michele; Lapenna, Elisabetta; Verzini, Alessandro; La Canna, Giovanni; Grimaldi, Antonio; Torracca, Lucia; Maisano, Francesco; Alfieri, Ottavio.

In: Annals of Thoracic Surgery, Vol. 85, No. 3, 03.2008, p. 932-939.

Research output: Contribution to journalArticle

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title = "Recurrence of Mitral Regurgitation Parallels the Absence of Left Ventricular Reverse Remodeling After Mitral Repair in Advanced Dilated Cardiomyopathy",
abstract = "Background: The aim of this study was to assess the occurrence of reverse left ventricular (LV) remodeling after effective mitral valve repair in advanced dilated cardiomyopathy and its impact on clinical outcome and repair durability. Methods: Of 111 patients undergoing mitral valve repair in ischemic or idiopathic dilated cardiomyopathy, 79 patients with no or trivial residual mitral regurgitation (MR) at discharge and with a follow-up length of at least 6 months were included in this study. Preoperatively they had 3 to 4+ functional MR, an ejection fraction of 0.28 ± 0.055, an indexed LV end-diastolic volume of 113 ± 33.0 mL/m2, an indexed LV end-systolic volume of 80.8 ± 26.3 mL/m2, a tenting area of 2.7 ± 0.9 cm2, and a coaptation depth of 1.1 ± 0.3 cm. Sixty-three patients (79.8{\%}) were in New York Heart Association class III or IV. A complete, rigid or semirigid undersized ring annuloplasty (with or without {"}edge-to-edge{"}) was used. Concomitant procedures were coronary artery bypass grafting (49 of 79 patients, 62{\%}), tricuspid valve repair (11 of 79 patients, 13.9{\%}), and ablation of permanent atrial fibrillation (13 of 79 patients, 16.4{\%}). Results: At a mean follow-up of 2 ± 1.3 years (median, 1.8 years), LV reverse remodeling was documented in 41 patients (51.8{\%}), whereas in 38 patients (48.1{\%}) LV dimensions remained unchanged or increased compared with preoperative values. The persistence or progression of LV remodeling paralleled the recurrence of MR and worsening of symptoms. Recurrence of MR of 3+ or greater was 0{\%} in the {"}reverse remodeling{"} group and 18.4{\%} in the {"}no reverse remodeling{"} one (p = 0.008). At 3 years, freedom from recurrence of MR of 2+ or greater was 74{\%} ± 11.7{\%} and 62{\%} ± 9.2{\%} (p = 0.004) and New York Heart Association class was 1.5 ± 0.61 and 2 ± 0.72 (p <0.0001), respectively. Predictors of reverse remodeling were ischemic etiology (p = 0.04), concomitant coronary artery bypass grafting (p = 0.02), successful ablation of atrial fibrillation (p = 0.05), and shorter history of congestive heart failure (p = 0.06). The use of the edge-to-edge showed a trend toward favoring reverse remodeling compared with isolated annuloplasty (p = 0.08). Conclusions: In patients with functional MR undergoing effective repair, the occurrence of reverse LV remodeling is associated with longer repair durability and a better clinical outcome compared with those with persistence or progression of the remodeling process.",
author = "{De Bonis}, Michele and Elisabetta Lapenna and Alessandro Verzini and {La Canna}, Giovanni and Antonio Grimaldi and Lucia Torracca and Francesco Maisano and Ottavio Alfieri",
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language = "English",
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T1 - Recurrence of Mitral Regurgitation Parallels the Absence of Left Ventricular Reverse Remodeling After Mitral Repair in Advanced Dilated Cardiomyopathy

AU - De Bonis, Michele

AU - Lapenna, Elisabetta

AU - Verzini, Alessandro

AU - La Canna, Giovanni

AU - Grimaldi, Antonio

AU - Torracca, Lucia

AU - Maisano, Francesco

AU - Alfieri, Ottavio

PY - 2008/3

Y1 - 2008/3

N2 - Background: The aim of this study was to assess the occurrence of reverse left ventricular (LV) remodeling after effective mitral valve repair in advanced dilated cardiomyopathy and its impact on clinical outcome and repair durability. Methods: Of 111 patients undergoing mitral valve repair in ischemic or idiopathic dilated cardiomyopathy, 79 patients with no or trivial residual mitral regurgitation (MR) at discharge and with a follow-up length of at least 6 months were included in this study. Preoperatively they had 3 to 4+ functional MR, an ejection fraction of 0.28 ± 0.055, an indexed LV end-diastolic volume of 113 ± 33.0 mL/m2, an indexed LV end-systolic volume of 80.8 ± 26.3 mL/m2, a tenting area of 2.7 ± 0.9 cm2, and a coaptation depth of 1.1 ± 0.3 cm. Sixty-three patients (79.8%) were in New York Heart Association class III or IV. A complete, rigid or semirigid undersized ring annuloplasty (with or without "edge-to-edge") was used. Concomitant procedures were coronary artery bypass grafting (49 of 79 patients, 62%), tricuspid valve repair (11 of 79 patients, 13.9%), and ablation of permanent atrial fibrillation (13 of 79 patients, 16.4%). Results: At a mean follow-up of 2 ± 1.3 years (median, 1.8 years), LV reverse remodeling was documented in 41 patients (51.8%), whereas in 38 patients (48.1%) LV dimensions remained unchanged or increased compared with preoperative values. The persistence or progression of LV remodeling paralleled the recurrence of MR and worsening of symptoms. Recurrence of MR of 3+ or greater was 0% in the "reverse remodeling" group and 18.4% in the "no reverse remodeling" one (p = 0.008). At 3 years, freedom from recurrence of MR of 2+ or greater was 74% ± 11.7% and 62% ± 9.2% (p = 0.004) and New York Heart Association class was 1.5 ± 0.61 and 2 ± 0.72 (p <0.0001), respectively. Predictors of reverse remodeling were ischemic etiology (p = 0.04), concomitant coronary artery bypass grafting (p = 0.02), successful ablation of atrial fibrillation (p = 0.05), and shorter history of congestive heart failure (p = 0.06). The use of the edge-to-edge showed a trend toward favoring reverse remodeling compared with isolated annuloplasty (p = 0.08). Conclusions: In patients with functional MR undergoing effective repair, the occurrence of reverse LV remodeling is associated with longer repair durability and a better clinical outcome compared with those with persistence or progression of the remodeling process.

AB - Background: The aim of this study was to assess the occurrence of reverse left ventricular (LV) remodeling after effective mitral valve repair in advanced dilated cardiomyopathy and its impact on clinical outcome and repair durability. Methods: Of 111 patients undergoing mitral valve repair in ischemic or idiopathic dilated cardiomyopathy, 79 patients with no or trivial residual mitral regurgitation (MR) at discharge and with a follow-up length of at least 6 months were included in this study. Preoperatively they had 3 to 4+ functional MR, an ejection fraction of 0.28 ± 0.055, an indexed LV end-diastolic volume of 113 ± 33.0 mL/m2, an indexed LV end-systolic volume of 80.8 ± 26.3 mL/m2, a tenting area of 2.7 ± 0.9 cm2, and a coaptation depth of 1.1 ± 0.3 cm. Sixty-three patients (79.8%) were in New York Heart Association class III or IV. A complete, rigid or semirigid undersized ring annuloplasty (with or without "edge-to-edge") was used. Concomitant procedures were coronary artery bypass grafting (49 of 79 patients, 62%), tricuspid valve repair (11 of 79 patients, 13.9%), and ablation of permanent atrial fibrillation (13 of 79 patients, 16.4%). Results: At a mean follow-up of 2 ± 1.3 years (median, 1.8 years), LV reverse remodeling was documented in 41 patients (51.8%), whereas in 38 patients (48.1%) LV dimensions remained unchanged or increased compared with preoperative values. The persistence or progression of LV remodeling paralleled the recurrence of MR and worsening of symptoms. Recurrence of MR of 3+ or greater was 0% in the "reverse remodeling" group and 18.4% in the "no reverse remodeling" one (p = 0.008). At 3 years, freedom from recurrence of MR of 2+ or greater was 74% ± 11.7% and 62% ± 9.2% (p = 0.004) and New York Heart Association class was 1.5 ± 0.61 and 2 ± 0.72 (p <0.0001), respectively. Predictors of reverse remodeling were ischemic etiology (p = 0.04), concomitant coronary artery bypass grafting (p = 0.02), successful ablation of atrial fibrillation (p = 0.05), and shorter history of congestive heart failure (p = 0.06). The use of the edge-to-edge showed a trend toward favoring reverse remodeling compared with isolated annuloplasty (p = 0.08). Conclusions: In patients with functional MR undergoing effective repair, the occurrence of reverse LV remodeling is associated with longer repair durability and a better clinical outcome compared with those with persistence or progression of the remodeling process.

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