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RESEARCH PRODUCT
A Comparison of 2 Mitral Annuloplasty Rings for Severe Ischemic Mitral Regurgitation: Clinical and Echocardiographic Outcomes.
Marco MoscarelliFrancesco GuccionePietro DioguardiKhalil FattouchGiuseppe SpezialePatrizio LancellottiSebastiano Castrovincisubject
MaleMitral Valve AnnuloplastyTime FactorsMyocardial IschemiaHemodynamics030204 cardiovascular system & hematologySeverity of Illness IndexVentricular Function Left0302 clinical medicinePostoperative ComplicationsRecurrenceMitral valve annuloplastyMitral valve030212 general & internal medicineHospital MortalityHeart Valve Prosthesis ImplantationExercise ToleranceIschemic mitral regurgitationMitral Valve InsufficiencyGeneral MedicineMiddle Agedmedicine.anatomical_structureTreatment OutcomeItalyHeart Valve ProsthesisCardiologyMitral ValveFemaleCardiology and Cardiovascular MedicineArteryEchocardiography StressPulmonary and Respiratory Medicinemedicine.medical_specialtyProsthesis Design03 medical and health sciencesInternal medicinemedicine.arterymedicineHumansMitral AnnuloplastyAgedRetrospective StudiesMitral regurgitationbusiness.industryRecovery of FunctionSurgeryPulmonary arteryChronic DiseaseExercise TestSurgerybusinessdescription
Controversies regarding the choice of annuloplasty rings for treatment of ischemic mitral regurgitation still exist. Aim of the study is to compare early performance of 2 different rings in terms of rest and exercise echocardiographic parameters (transmitral gradient, systolic pulmonary artery pressure, and mitral valve area), clinical outcomes, and recurrence of mitral regurgitation. From January 2008 till December 2013, prospectively collected data of patients who underwent coronary artery bypass grafting and undersizing mitral valve annuloplasty for severe chronic ischemic mitral regurgitation at our Institution were reviewed. A total of 93 patients were identified; among them 44 had semirigid Memo 3D ring implanted (group A) whereas 49 had a rigid profile 3D ring (group B). At 6 months, recurrent ischemic mitral regurgitation, equal or more than moderate, was observed in 4 and 6 patients in the group A and B, respectively (P = 0.74). Group A showed certain improved valve geometric parameters such as posterior leaflet angle, tenting area, and coaptation depth. Transmitral gradient was significantly higher at rest in the group B (P < 0.0001). During exercise, significant increase of transmitral gradient and systolic pulmonary artery pressure was observed in group B (P < 0.0001). Mitral valve area was not statistically significantly smaller at rest in between groups (P = 0.09); however, it significantly decreased with exercise in group B (P = 0.01). At midterm follow-up, patients in group B were more symptomatic. In patients with chronic ischemic mitral regurgitation, use of semirigid Memo 3D ring when compared to the rigid Profile 3D may be associated with early improved mitral valve geometrical conformation and hemodynamic profile, particularly during exercise. No difference was observed between both groups in recurrent mitral regurgitation.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2016-04-18 | Seminars in thoracic and cardiovascular surgery |