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Ann Thorac Surg 2007;83:1303-1309
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Edge-to-Edge Mitral Repair Without Annuloplasty in Combination With Surgical Ventricular Restoration

^a Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden
^b Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
^c Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

Accepted for publication November 21, 2006.

^_* Address correspondence to Dr Sartipy, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, SE-17176 Stockholm, Sweden (Email: ulrik.sartipy{at}karolinska.se).

Background: Functional mitral regurgitation is common in ischemic dilated cardiomyopathy. Edge-to-edge repair is an option for correction and can be performed through the ventriculotomy during surgical ventricular restoration (SVR). This report describes the durability of the edge-to-edge repair without annuloplasty in combination with SVR.

Methods: From March 1997 to July 2002, 31 patients with left ventricular aneurysm or ischemic dilated cardiomyopathy and functional ischemic mitral regurgitation grade II (n = 18), III (n = 10), and IV (n = 3) underwent SVR and edge-to-edge repair without annuloplasty with concomitant coronary artery bypass grafting. Long-term valve competence was assessed by echocardiography. Early and late survival and hospital readmission for heart failure were analyzed.

Results: Early mortality was 5 (16%) of 31 patients. At 1, 3, and 5 years, actuarial survival was 77%, 55%, and 48%. The cumulative follow-up was 117 patient-years (4.5 years mean follow-up). Late echocardiograms performed at a mean of 3.1 years postoperatively showed patients had mitral regurgitation at grade 0 (n = 4), I (n = 10), II (n = 9), and III (n = 1). Two patients underwent reoperation owing to grade III–IV recurrent mitral regurgitation. Freedom from hospital readmission or cardiac death was 56% at 1 year and 48% at 3 years.

Conclusions: Combined mitral valve repair and SVR carries high operative risk and long-term prognosis is worse than after SVR alone. The edge-to-edge repair without annuloplasty for functional ischemic mitral regurgitation seems to be fairly durable in conjunction with SVR. To improve results a transventricular annuloplasty may be added.

This article has been cited by other articles:

				D. Lindblom, A. Albage, and U. Sartipy Surgery for ventricular tachycardia in patients undergoing surgical ventricular restoration MMCTS, December 17, 2007; 2007(1217): 2816. [Abstract] [Full Text] [PDF]

				M. Di Donato, S. Castelvecchio, J. Brankovic, C. Santambrogio, V. Montericcio, and L. Menicanti Effectiveness of surgical ventricular restoration in patients with dilated ischemic cardiomyopathy and unrepaired mild mitral regurgitation. J. Thorac. Cardiovasc. Surg., December 1, 2007; 134(6): 1548 - 1553. [Abstract] [Full Text] [PDF]