PMID- 15364847
OWN - NLM
STAT- MEDLINE
DCOM- 20050425
LR  - 20220316
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 110
IP  - 11 Suppl 1
DP  - 2004 Sep 14
TI  - Restrictive annuloplasty and coronary revascularization in ischemic mitral 
      regurgitation results in reverse left ventricular remodeling.
PG  - II103-8
AB  - BACKGROUND: Data on combined coronary artery bypass grafting (CABG) and 
      restrictive annuloplasty in patients with ischemic cardiomyopathy are scarce, and 
      the effect on reverse left ventricular (LV) remodeling is unknown. METHODS AND 
      RESULTS: 51 patients with ischemic LV dysfunction (LV ejection fraction 31+/-8%) 
      and severe mitral regurgitation (grade 3 to 4+) underwent CABG and restrictive 
      annuloplasty with stringent downsizing of the mitral annulus (by 2 sizes, 
      Physio-ring, mean size 28+/-2). Serial transthoracic echocardiographic studies 
      were performed (before surgery and within 3 months and 1.5 years after surgery) 
      to assess mitral regurgitation, transmitral gradient, leaflet coaptation, and 
      left atrial and LV reverse remodeling. Clinical follow-up (New York Heart 
      Association [NYHA] class, survival, events) was assessed at 2-year follow-up. 
      Early operative mortality was 5.6%; at 2-year follow-up, all patients were free 
      of endocarditis and thromboembolism, and 1 needed re-operation for recurrent 
      mitral regurgitation; 2-year survival was 84%. NYHA class improved from 3.4+/-0.8 
      to 1.3+/-0.4 (P<0.01), with all patients in class I/II. Intraoperative 
      transesophageal echo showed minimal (grade 1+) mitral regurgitation in 8 patients 
      and none in 43, without stenosis. Leaflet coaptation was 0.8+/-0.2 cm. These 
      values remained unchanged; all patients had no or minimal (grade 1+) mitral 
      regurgitation at 2-year follow-up. LV end-systolic and end-diastolic dimensions 
      decreased from 51+/-10 to 43+/-12 mm (P<0.001) and from 64+/-8 to 58+/-11 mm 
      (P<0.001). Left atrial dimension decreased from 53+/-8 to 47+/-7 mm (P<0.001). 
      CONCLUSIONS: Excellent results of combined restrictive annuloplasty and CABG were 
      obtained. Residual mitral regurgitation was absent/minimal at 2-year follow-up, 
      associated with a significant reduction in left atrial dimension and LV reverse 
      remodeling.
FAU - Bax, Jeroen J
AU  - Bax JJ
AD  - Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 
      ZA Leiden, The Netherlands. jbax@knoware.nl
FAU - Braun, Jerry
AU  - Braun J
FAU - Somer, Soeresh T
AU  - Somer ST
FAU - Klautz, Robert
AU  - Klautz R
FAU - Holman, Eduard R
AU  - Holman ER
FAU - Versteegh, Michel I M
AU  - Versteegh MI
FAU - Boersma, Eric
AU  - Boersma E
FAU - Schalij, Martin J
AU  - Schalij MJ
FAU - van der Wall, Ernst E
AU  - van der Wall EE
FAU - Dion, Robert A
AU  - Dion RA
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
SB  - IM
MH  - Acute Disease
MH  - Aged
MH  - *Coronary Artery Bypass
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve Insufficiency/diagnostic imaging/etiology/*surgery
MH  - Myocardial Ischemia/complications/*surgery
MH  - Postoperative Complications
MH  - Stroke Volume
MH  - Treatment Outcome
MH  - Ultrasonography
MH  - *Ventricular Remodeling
EDAT- 2004/09/15 05:00
MHDA- 2005/04/26 09:00
CRDT- 2004/09/15 05:00
PHST- 2004/09/15 05:00 [pubmed]
PHST- 2005/04/26 09:00 [medline]
PHST- 2004/09/15 05:00 [entrez]
AID - 110/11_suppl_1/II-103 [pii]
AID - 10.1161/01.CIR.0000138196.06772.4e [doi]
PST - ppublish
SO  - Circulation. 2004 Sep 14;110(11 Suppl 1):II103-8. doi: 
      10.1161/01.CIR.0000138196.06772.4e.