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Ann Thorac Surg 2008;85:1319-1330. doi:10.1016/j.athoracsur.2007.12.074
© 2008 The Society of Thoracic Surgeons
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Sandro Gelsomino
Roberto Lorusso
Pierluigi Stefàno
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Original Articles: Adult Cardiac

Left Ventricular Reverse Remodeling After Undersized Mitral Ring Annuloplasty in Patients With Ischemic Regurgitation

Sandro Gelsomino, MDa,*, Roberto Lorusso, PhDb, Irene Capecchi, MDa, Carlo Rostagno, MDa, Stefano Romagnoli, MDa, Giuseppe Billè, MDa, Giuseppe De Cicco, MDb, Cecilia Tetta, MDa, Pierluigi Stefàno, MDa, Gian Franco Gensini, MDa

a Experimental Surgery Unit, Cardiac Surgery Unit, Department of Heart and Vessels, Careggi Hospital, Florence, Italy
b Cardiac Surgery Unit, Civic Hospital, Brescia, Italy

Accepted for publication December 31, 2007.

* Address correspondence to Dr Gelsomino, Experimental Surgery Unit, Careggi Hospital, Viale Morgagni 85, Florence, 50134, Italy (Email: sandro.gelsomino{at}libero.it).

Background: Long-term durability of combined coronary artery bypass grafting and of undersized mitral ring annuloplasty (UMRA) is uncertain. A considerable number of patients show recurrent regurgitation. This study examines the difference in the benefit of UMRA on clinical end points and recurrence of mitral regurgitation between responders and nonresponders of left ventricular reverse remodeling.

Methods: Study eligibility criteria were fulfilled by 204 patients with chronic ischemic mitral regurgitation (CIMR) who survived combined coronary artery bypass grafting and reductive annuloplasty between September 2001 and September 2006. Patients underwent echocardiography preoperatively, at discharge, and at follow-up appointments (100% complete). Median early follow-up was 6 months (interquartile range [IRQ], 3 to 8 months; late follow-up, 35 months (IRQ, 21 to 50 months). Reverse remodeling was considered a reduction in left ventricular end systolic volume index exceeding 15%.

Results: There were 84 responders (41.2%) of reverse remodeling (age, 68 ± 7.4 years; 51 men) and 120 nonresponders (58.8%; age, 67 ± 7.6 years; 78 men). Nonresponders had a higher recurrence of mitral regurgitation (p < 0.001), higher reoperation rate for failed repair (p < 0.001), and significantly larger left ventricular volumes and dimension at any study point (p < 0.001), with significant late increase of sphericity indexes exceeding preoperative values (p < 0.001). At multivariable analysis, a baseline myocardial performance index of less than 0.90 (p < 0.001), a systolic sphericity index of less than 0.72 (p < 0.001), and wall motion score index of less than 1.59 (p = 0.003) were independent predictors of reverse remodeling.

Conclusions: Our experience suggests that more information on possible echo predictors of an inadequate result may improve preoperative decision making of CIMR patients for UMRA.


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