Gatti Giuseppe, Dell'Angela Luca, Pinamonti Bruno, Gon Livio, Benussi Bernardo, Sinagra Gianfranco, Pappalardo Aniello
J Heart Valve Dis. 2014 Nov;23(6):695-706.
The Carpentier-McCarthy-Adams IMR ETlogix annuloplasty ring was specifically designed to treat ischemic mitral regurgitation (IMR) associated with asymmetric mitral annular dilation and leaflet tethering. The study aim was to review, retrospectively, the results of mitral annuloplasty with this asymmetric ring in a representative number of patients.
Between January 2005 and July 2012, the IMR ETlogix ring was implanted in 190 consecutive patients (mean age 69.5 +/- 7.6 years) with grade > or =2+ IMR (graded from 0 to 3+). Preoperatively, 37 patients (19.5%) were in NYHA class IV, and 73 (38.4%) suffered from unstable angina. The operative risk according to the European System for Cardiac Operative Risk Evaluation II was 15.6 +/- 14.5%. Using two- dimensional echocardiography, postoperative changes in mitral annular diameter (MAD) and tenting height (TH) of the mitral valve in four-chamber, two-chamber and long-axis views, were assessed at mid-systole.
Thirty-eight patients (20.0%) received one or more concomitant major cardiac surgical procedure(s) other than, or in addition to, coronary artery bypass grafting or tricuspid valve annuloplasty. Nineteen (10.0%) hospital deaths occurred, and one patient underwent immediate reoperation for residual MR. During the follow up (mean 4.8 +/- 2.1 years) there were 26 cardiac deaths, 14 non-cardiac deaths, and three mitral valve replacements. The seven-year actuarial survival, freedom from grade > or =2+ MR and reoperation were 62.0%, 93.1% and 97.6%, respectively. Renal impairment (p = 0.012) and extracardiac arteriopathy (p = 0.047) were predictors of death; bilateral internal thoracic artery grafting was a protective factor (p = 0.033). Heart failure symptoms were improved (p <0.01). Left ventricular reverse remodeling was achieved in 50.6% of patients. The MAD and TH were each decreased in all three echocardiographic views (p < 0.001), the reductions being greater in the long-axis view.
By restoring the mitral apparatus geometry and competence, asymmetric annuloplasty with the IMR ETlogix ring provides good mid-term outcomes and helps left ventricular reverse remodeling in IMR.
卡彭蒂埃-麦卡锡-亚当斯IMR ETlogix瓣环成形环专门设计用于治疗与不对称二尖瓣环扩张和瓣叶牵拉相关的缺血性二尖瓣反流（IMR）。本研究目的是回顾性分析在一定数量有代表性的患者中使用这种不对称瓣环成形环进行二尖瓣瓣环成形术的结果。
2005年1月至2012年7月期间，连续190例（平均年龄69.5±7.6岁）IMR分级≥2+（分级为0至3+）的患者植入了IMR ETlogix瓣环成形环。术前，37例（19.5%）患者为纽约心脏协会（NYHA）心功能IV级，73例（38.4%）患有不稳定型心绞痛。根据欧洲心脏手术风险评估系统II，手术风险为15.6±14.5%。使用二维超声心动图，在收缩中期评估四腔心、两腔心和长轴视图中二尖瓣瓣环直径（MAD）和瓣叶帐篷高度（TH）的术后变化。
38例（20.0%）患者接受了除冠状动脉旁路移植术或三尖瓣瓣环成形术之外或在此基础上的一项或多项同期心脏大手术。19例（10.0%）患者术后死亡，1例患者因残余二尖瓣反流立即再次手术。在随访期间（平均4.8±2.1年），有26例心脏死亡、14例非心脏死亡以及3例二尖瓣置换术。7年实际生存率、无≥2+级二尖瓣反流生存率和再次手术率分别为62.0%、93.1%和97.6%。肾功能损害（p = 0.012）和心脏外动脉病变（p = 0.047）是死亡的预测因素；双侧胸廓内动脉移植是一个保护因素（p = 0.033）。心力衰竭症状得到改善（p <0.01）。50.6%的患者实现了左心室逆向重构。在所有三个超声心动图视图中，MAD和TH均降低（p <0.001），长轴视图中的降低幅度更大。
通过恢复二尖瓣装置的几何形态和功能，使用IMR ETlogix瓣环成形环进行不对称瓣环成形术可提供良好的中期结果，并有助于IMR患者的左心室逆向重构。
