Background: Coronary artery bypass grafting (CABG) results in improved left ventricular (LV) performance and reduced ischemic mitral regurgitation (IMR). However, MR often does not resolve and correlates with a poor prognosis. Benefits of repair have been reported also in mild‐to‐moderate IMR, but optimal surgical treatment for intermediate‐degree IMR remains widely debated. Methods: CABG combined with implantation of an undersized autologous pericardial band, or of a flexible or semirigid complete prosthetic ring was performed in 75 patients with 2+ or 3+ IMR. Longest follow‐up was 10 years. Results: Preoperative LV end‐systolic volume index was the strongest predictor of early postoperative outcome at multivariable logistic regression analysis, and showed a correlation with end‐systolic volume index (p<0.001, R2=0.65) and ejection fraction (p<0.001, R2=0.43) early after repair. However, a more compromised ejection fraction and end‐systolic volume index at baseline predicted a comparatively greater early functional improvement, but, in parallel, a higher residual postoperative end‐systolic volume index (p<0.01). Wall motion score index was identified as the best baseline predictor of late death and heart failure, whereas regional infero‐posterior wall motion resulted the strongest predictor of recurrent IMR at Cox multivariable analysis (p<0.01). More rigid annuloplasty determined a higher probability of ejection fraction and wall motion improvement, and of the occurrence and earlier timing of LV reverse remodeling, expressed as different degrees of end‐systolic volume index reduction (p<0.001, hazard ratio >5). Conclusions: Undersized mitral annuloplasty combined to CABG unloads the LV in patients with intermediate‐degree IMR. Global and regional wall motion predict late outcome, whereas a stiffer mitral annular stabilization promotes functional recovery and predicts higher probability and earlier timing of LV reverse remodelling.

Reverse left ventricular remodeling after undersized annuloplasty for ischemic mitral regurgitation / Marco, Pocar; Moneta, Andrea; Di Mauro, Alessandra; Passolunghi, Davide; Bregasi, Alda; Clerici, Alberto; Donatelli, Francesco - In: Isreal Heart Society, 58th Annual Conference, abstract bookSTAMPA. - [s.l] : Israel Heart Society, 2011.

Reverse left ventricular remodeling after undersized annuloplasty for ischemic mitral regurgitation

CLERICI, ALBERTO;
2011

Abstract

Background: Coronary artery bypass grafting (CABG) results in improved left ventricular (LV) performance and reduced ischemic mitral regurgitation (IMR). However, MR often does not resolve and correlates with a poor prognosis. Benefits of repair have been reported also in mild‐to‐moderate IMR, but optimal surgical treatment for intermediate‐degree IMR remains widely debated. Methods: CABG combined with implantation of an undersized autologous pericardial band, or of a flexible or semirigid complete prosthetic ring was performed in 75 patients with 2+ or 3+ IMR. Longest follow‐up was 10 years. Results: Preoperative LV end‐systolic volume index was the strongest predictor of early postoperative outcome at multivariable logistic regression analysis, and showed a correlation with end‐systolic volume index (p<0.001, R2=0.65) and ejection fraction (p<0.001, R2=0.43) early after repair. However, a more compromised ejection fraction and end‐systolic volume index at baseline predicted a comparatively greater early functional improvement, but, in parallel, a higher residual postoperative end‐systolic volume index (p<0.01). Wall motion score index was identified as the best baseline predictor of late death and heart failure, whereas regional infero‐posterior wall motion resulted the strongest predictor of recurrent IMR at Cox multivariable analysis (p<0.01). More rigid annuloplasty determined a higher probability of ejection fraction and wall motion improvement, and of the occurrence and earlier timing of LV reverse remodeling, expressed as different degrees of end‐systolic volume index reduction (p<0.001, hazard ratio >5). Conclusions: Undersized mitral annuloplasty combined to CABG unloads the LV in patients with intermediate‐degree IMR. Global and regional wall motion predict late outcome, whereas a stiffer mitral annular stabilization promotes functional recovery and predicts higher probability and earlier timing of LV reverse remodelling.
2011
Isreal Heart Society, 58th Annual Conference, abstract book
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11583/2692808
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