PMID- 21232967
OWN - NLM
STAT- MEDLINE
DCOM- 20120112
LR  - 20191210
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 40
IP  - 2
DP  - 2011 Aug
TI  - The GeoForm annuloplasty ring for the surgical treatment of functional mitral 
      regurgitation in advanced dilated cardiomyopathy.
PG  - 488-95
LID - 10.1016/j.ejcts.2010.11.048 [doi]
AB  - OBJECTIVE: To assess the results of the three-dimensional (3D)-shaped GeoForm 
      ring for the treatment of functional mitral regurgitation (FMR). METHODS: 
      Seventy-four patients with severe FMR and systolic dysfunction underwent GeoForm 
      ring implantation. Forty-six patients (62%) were in the New York Heart 
      Association (NYHA) class III-IV. Concomitant procedures were coronary artery 
      bypass grafting (CABG) (33 patients (pts)), tricuspid repair (23 pts), atrial 
      fibrillation ablation (20 pts), aortic valve replacement (eight pts) and 
      left-ventricular (LV) reconstruction (five pts). RESULTS: Hospital mortality was 
      9%. Three more patients died after hospital discharge. Overall survival was 81.1 
      +/- 6.6% at 3.5 years. The 67 hospital survivors underwent clinical and 
      echocardiographic follow-up at a mean follow-up period of 1.9 +/- 1.25 years 
      (median 1.7 years). MR was absent or mild in 83% of the patients (56/67), 
      moderate in 7% (5/67), and moderate to severe in the remaining 9% (6/67). At 3.5 
      years, overall freedom from MR >/= 3+ was 85.1 +/- 8% and freedom from MR >/= 2+ was 
      75.1 +/- 8.6%. Statistical analysis identified preoperative asymmetric tethering 
      with prevalent restricted motion of the posterior leaflet as the only predictor 
      of recurrence of MR >/= 2+ (hazard ratio (HR) 6.1, p=0.005). Reverse LV remodeling 
      was demonstrated in 31 of the 54 patients eligible for this specific analysis 
      (31/54, 57%): Both LV end-diastolic and end-systolic volumes indexed 
      significantly decreased (both p=0.0001) as well as systolic pulmonary artery 
      pressure (SPAP) (p=0.006). Ejection fraction increased from 33 +/- 8% to 43 +/- 8% 
      (p<0.0001). Stress echocardiography was performed in a subgroup of eight 
      patients. Mean mitral area at rest was 2.2 +/- 0.3 cm(2) and did not change during 
      stress. Cardiac output significantly increased in all patients during exercise. 
      Although mean and peak transmitral gradients were 3.3 +/- 1.3 and 8.1 +/- 2.2 mmHg at 
      rest and 6.6 +/- 2.5 and 14.8 +/- 3.9 mmHg under stress, respectively (both p<0.003), 
      the increase in SPAP was not statistically significant (28 +/- 3.0 vs 31 +/- 7.5 mm 
      Hg, p=0.17), revealing a preserved cardiac adaptation to exercise. CONCLUSIONS: 
      The GeoForm ring is effective in relieving FMR in most of the patients with 
      dilated cardiomyopathy. In presence of prevalent restricted motion of the 
      posterior leaflet, recurrence of significant MR is more likely to occur. 
      Clinically relevant mitral stenosis was not detected during exercise.
CI  - Copyright (c) 2010 European Association for Cardio-Thoracic Surgery. Published by 
      Elsevier B.V. All rights reserved.
FAU - De Bonis, Michele
AU  - De Bonis M
AD  - Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy. 
      michele.debonis@hsr.it
FAU - Taramasso, Maurizio
AU  - Taramasso M
FAU - Grimaldi, Antonio
AU  - Grimaldi A
FAU - Maisano, Francesco
AU  - Maisano F
FAU - Calabrese, Maria Chiara
AU  - Calabrese MC
FAU - Verzini, Alessandro
AU  - Verzini A
FAU - Ferrara, David
AU  - Ferrara D
FAU - Alfieri, Ottavio
AU  - Alfieri O
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
DEP - 20110112
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
CIN - Eur J Cardiothorac Surg. 2012 Apr;41(4):964; author reply 964-5. PMID: 22423071
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiomyopathy, Dilated/*complications
MH  - Echocardiography, Stress/methods
MH  - Epidemiologic Methods
MH  - Exercise Test/methods
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve Annuloplasty/*instrumentation/methods
MH  - Mitral Valve Insufficiency/diagnostic imaging/etiology/*surgery
MH  - *Prostheses and Implants
MH  - Prosthesis Design
MH  - Recurrence
MH  - Treatment Outcome
MH  - Ventricular Remodeling/physiology
EDAT- 2011/01/15 06:00
MHDA- 2012/01/13 06:00
CRDT- 2011/01/15 06:00
PHST- 2010/08/30 00:00 [received]
PHST- 2010/11/13 00:00 [revised]
PHST- 2010/11/16 00:00 [accepted]
PHST- 2011/01/15 06:00 [entrez]
PHST- 2011/01/15 06:00 [pubmed]
PHST- 2012/01/13 06:00 [medline]
AID - S1010-7940(10)01009-2 [pii]
AID - 10.1016/j.ejcts.2010.11.048 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2011 Aug;40(2):488-95. doi: 10.1016/j.ejcts.2010.11.048. 
      Epub 2011 Jan 12.