Mitral annuloplasty with IMR ETlogix ring for ischemic mitral regurgitation and left ventricular dysfunction.

BACKGROUND AND AIM OF THE STUDY

Chronic ischemic mitral regurgitation (IMR) is associated with asymmetric mitral leaflet tethering and annular dilation. The Carpentier-McCarthy-Adams IMR ETlogix annuloplasty ring is designed specifically to treat these asymmetric pathological changes. In the present study, the results of mitral annuloplasty with this ring in a selected subset of patients with significant IMR and left ventricular (LV) dysfunction were analyzed.

METHODS

Between May 2005 and September 2009, the IMR ETlogix ring was implanted in 140 consecutive patients with grade > OR = 2+ IMR (graded from 0 to 3+). Of these patients, 41 (29%) suffered from preoperative LV dysfunction (defined as LV ejection fraction < OR = 0.35). Ten of these 41 patients underwent combined aortic valve replacement or LV restoration, and thus were excluded from this retrospective study; consequently, 31 patients (mean age 67.1 +/- 7.7 years) were enrolled into the study. Preoperatively, 18 patients (58%) were in NYHA class III or IV, and 16 (52%) were in CCS class 3 or 4. The expected operative risk according to the logistic EuroSCORE was 22.4 +/- 16.5%. Using two-dimensional echocardiography, postoperative changes in the mitral annular diameter (MAD), tethering area (TA), and tenting height (TH) of the mitral valve in four-chamber, two-chamber, and long-axis views, were assessed at mid-systole.

RESULTS

All patients underwent complete myocardial revascularization. One (3%) in-hospital (non-cardiac) death occurred. During a mean follow up of 3.4 +/- 1.5 years (range: 0.2 to 5.9 years), one early mitral replacement was required (due to endocarditis), and there were two cardiac deaths and three non-cardiac deaths. The four-year actuarial survival and freedom from heart failure hospital readmission were 82% and 75%, respectively. Heart failure symptoms were improved (p = 0.001), and IMR was well controlled within grade 1+ (p < 0.0001) for the 24 remaining patients. The MAD, TA and TH were each decreased in all three echocardiographic views (p < OR = 0.0006). The MAD reduction was greater in the long-axis view than in the four-chamber (56% versus 49%, p = 0.002) and two-chamber (56% versus 43%, p = 0.0003) views.

CONCLUSION

In selected patients with chronic ischemic LV dysfunction, mitral annuloplasty with the IMR ETlogix ring, combined with complete myocardial revascularization, restored the mitral apparatus geometry and competence.