PMID- 19398083 OWN - NLM STAT- MEDLINE DCOM- 20100222 LR - 20090428 IS - 1532-8414 (Electronic) IS - 1071-9164 (Linking) VI - 15 IP - 4 DP - 2009 May TI - Selective treatment algorithm for mitral valve annuloplasty in nonischemic functional mitral regurgitation. PG - 341-6 LID - 10.1016/j.cardfail.2008.11.004 [doi] AB - BACKGROUND: The success rate of mitral annuloplasty (MA) for functional mitral regurgitation (FMR) varies. This study evaluated the effectiveness of this procedure in nonischemic dilated cardiomyopathy (DCM) patients after a selective treatment protocol was followed. METHODS AND RESULTS: This study analyzed 42 patients with nonischemic DCM and FMR (mean regurgitation grade, 3.6 +/- 0.3), aged a mean 56.5 +/- 15 years (range, 25 to 78 years), who underwent MA from April 2003 to December 2007. The analysis excluded patients with coronary artery disease, or mitral leaflets or subvalvular pathologies. All patients had taken maximal medications for at least 3 months and were still in New York Heart Association (NYHA) functional class III to IV (mean, 3.2 +/- 0.4). Mean ejection fraction (EF) was 31.4% +/- 12.9% (range, 8% to 58%), and left ventricular end-diastolic diameter (LVEDD) was 66.0 +/- 8.3 mm (range, 55 to 85 mm). Downsized Carpentier Physio ring (Carpentier-Edwards, Irvine, California) annuloplasty, mean size 26.3 +/- 2.3 (range, 24 to 30), was the preferred procedure. Concomitant procedures included 23 tricuspid valve repairs and 10 Maze operations for atrial fibrillation. Echocardiography was performed at early (12 months; mean 29.5 +/- 13.4 months) follow-up. All late deaths and readmissions were recorded. One (2.4%) in-hospital death occurred due to low cardiac output. Follow-up was completed in 40 of 41 (97.6%) patients (mean duration, 31.9 +/- 16.1; range, 3.9 to 59.2 months). Eight (19.5%) patients were readmitted for heart failure, including 2 late MRs due to ring dehiscence and infective endocarditis. Three of 5 deaths during the follow-up period were attributed to cardiac death. Actuarial survival after 1 and 3 years was 88.9% and 79.2%, respectively. The number of patients treated with beta-blockers increased after operation, from 52.4% to 75.6% (P = .028). NYHA class decreased from 3.2 +/- 0.4 to 1.3 +/- 0.6 (P < .0001). Echo examination revealed left heart reverse remodeling and improved performance in all follow-up time frames. CONCLUSION: This study shows that MA in patients with non-ischemic DCM and FMR is feasible and associated with reasonable short and long term outcomes. FAU - Chen, Shao-Wei AU - Chen SW AD - Section of Cardiac Surgery, Chang Gung Institute of Technology, Chia-Yi, Taoyuan, Taiwan. FAU - Tsai, Feng-Chun AU - Tsai FC FAU - Tsai, Feng-Chang AU - Tsai FC FAU - Chen, Chun-Chi AU - Chen CC FAU - Wang, Chun-Li AU - Wang CL FAU - Wu, Mon-Yue AU - Wu MY FAU - Huang, Yao-Kuang AU - Huang YK FAU - Chu, Jaw-Ji AU - Chu JJ FAU - Lin, Pyng Jing AU - Lin PJ LA - eng PT - Comparative Study PT - Journal Article DEP - 20081223 PL - United States TA - J Card Fail JT - Journal of cardiac failure JID - 9442138 SB - IM MH - Adult MH - Aged MH - *Algorithms MH - Disease Management MH - Female MH - Follow-Up Studies MH - Heart Valve Prosthesis/standards MH - Heart Valve Prosthesis Implantation/instrumentation/*methods/standards MH - Humans MH - Male MH - Middle Aged MH - Mitral Valve/pathology/surgery MH - Mitral Valve Insufficiency/*pathology/*surgery MH - Prosthesis Design/standards EDAT- 2009/04/29 09:00 MHDA- 2010/02/23 06:00 CRDT- 2009/04/29 09:00 PHST- 2008/06/07 00:00 [received] PHST- 2008/11/02 00:00 [revised] PHST- 2008/11/04 00:00 [accepted] PHST- 2009/04/29 09:00 [entrez] PHST- 2009/04/29 09:00 [pubmed] PHST- 2010/02/23 06:00 [medline] AID - S1071-9164(08)01083-X [pii] AID - 10.1016/j.cardfail.2008.11.004 [doi] PST - ppublish SO - J Card Fail. 2009 May;15(4):341-6. doi: 10.1016/j.cardfail.2008.11.004. Epub 2008 Dec 23.