PMID- 18782701
OWN - NLM
STAT- MEDLINE
DCOM- 20090409
LR  - 20141120
IS  - 1522-6662 (Electronic)
IS  - 1098-3511 (Linking)
VI  - 11
IP  - 4
DP  - 2008
TI  - Restrictive mitral valve annuloplasty for chronic ischemic mitral regurgitation: 
      a 5-year clinical experience with the physio ring.
PG  - E225-30
LID - 10.1532/HSF98.20081028 [doi]
AB  - BACKGROUND: This study investigated the results of restrictive mitral 
      annuloplasty with the semirigid Carpentier-Edwards Physio ring in patients with 
      moderately severe to severe chronic ischemic mitral regurgitation (IMR) and 
      advanced ischemic cardiomyopathy (ICM). METHODS: From 2003 to 2007, 100 
      consecutive patients (mean age +/- SD, 69 +/- 10 years) with chronic IMR of 
      grades 3 to 4 (3.6 +/- 0.5) and a left ventricular ejection fraction (LVEF) of 
      31% +/- 9% (range, 12%-45%) underwent standardized restrictive prosthetic ring 
      annuloplasty (ie, downsizing of 2.7 +/- 1.0 [range, 2-4] ring sizes) and 
      concomitant coronary artery bypass grafting. All surviving patients were 
      restudied 8 +/- 1 days, 3 +/- 1 months, and 2.5 +/- 1.0 years after surgery to 
      assess survival, residual MR, New York Heart Association (NYHA) class, and LV 
      function (end-systolic and end-diastolic dimension/volume indices and LVEF). Data 
      were analyzed exploratatively. RESULTS: Survival rates at the postoperative 
      reexamination times were 98%, 97%, and 94%, respectively (1 noncardiac and 5 
      cardiac deaths). NYHA class improved from 3.5 +/- 0.5 to 1.4 +/- 0.5 (P < .0005). 
      The residual MR grades at discharge, early follow-up, and late follow-up were 0.4 
      +/- 0.5, 0.5 +/- 0.5, and 0.4 +/- 0.6, respectively (P < .0005). Post-operative 
      recurrence of significant IMR (>grade 2) was absent in all patients. The leaflet 
      coaptation height was 8 +/- 1 mm and did not decrease significantly over time. 
      All LV dimension and volume indices and the LVEF (41% +/- 9% at 2.5 years) 
      improved significantly after surgery (P < .0005), even in patients with initially 
      severely reduced myocardial function and a preoperative LVEF of <30% (n = 42; 
      LVEF, 22% +/- 5% versus 33% +/- 6% at late follow-up; P < .0005). CONCLUSION: 
      Restrictive mitral valve annuloplasty using the semirigid Physio ring corrected 
      chronic IMR in ICM patients with very low mortality and improved contractility. 
      Surgery also prevented recurrence of significant IMR in parallel with the 
      phenomenon of postoperative continuous reverse myocardial remodeling.
FAU - Geidel, Stephan
AU  - Geidel S
AD  - Hanseatisches Herzzentrum, Abteilung fur Herzchirurgie, Asklepios Klinik St. 
      Georg, Hamburg, Germany. StGeidel@aol.com
FAU - Lass, Michael
AU  - Lass M
FAU - Ostermeyer, Jorg
AU  - Ostermeyer J
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Heart Surg Forum
JT  - The heart surgery forum
JID - 100891112
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Chronic Disease
MH  - Coronary Artery Bypass
MH  - Echocardiography
MH  - Equipment Design
MH  - Female
MH  - Follow-Up Studies
MH  - Heart/physiopathology
MH  - *Heart Valve Prosthesis
MH  - *Heart Valve Prosthesis Implantation
MH  - Humans
MH  - In Vitro Techniques
MH  - Intraoperative Period
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/*surgery
MH  - Mitral Valve Insufficiency/*etiology/mortality/physiopathology/*surgery
MH  - Myocardial Ischemia/*complications
MH  - Severity of Illness Index
MH  - Stroke Volume
MH  - Survival Analysis
MH  - Treatment Outcome
EDAT- 2008/09/11 09:00
MHDA- 2009/04/10 09:00
CRDT- 2008/09/11 09:00
PHST- 2008/09/11 09:00 [pubmed]
PHST- 2009/04/10 09:00 [medline]
PHST- 2008/09/11 09:00 [entrez]
AID - 1U127HK8500558V4 [pii]
AID - 10.1532/HSF98.20081028 [doi]
PST - ppublish
SO  - Heart Surg Forum. 2008;11(4):E225-30. doi: 10.1532/HSF98.20081028.