PMID- 22447810
OWN - NLM
STAT- MEDLINE
DCOM- 20130308
LR  - 20191210
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 42
IP  - 4
DP  - 2012 Oct
TI  - Long-term results of mitral repair for functional mitral regurgitation in 
      idiopathic dilated cardiomyopathy.
PG  - 640-6
LID - 10.1093/ejcts/ezs078 [doi]
AB  - OBJECTIVES: While the results of mitral repair in ischaemic mitral regurgitation 
      have been repeatedly reported, less data are available about the outcome of 
      surgical repair of functional mitral regurgitation (FMR) in idiopathic dilated 
      cardiomyopathy (iDCM) which represents the topic of this study. METHODS: 
      Fifty-four iDCM patients (mean age 63 +/- 10.5 years) underwent mitral valve repair 
      for severe FMR. Coronary angiography confirmed the absence of coronary disease in 
      all patients. Most of the patients (77.7%) were in New York Heart Association 
      (NYHA) class III-IV. Pre-operative ejection fraction (EF) was 30.4 +/- 8.5%, left 
      ventricle end-diastolic diameter (LVEDD) 67.5 +/- 7.8 mm, left ventricle 
      end-systolic diameter (LVESD) diameter 53.9 +/- 8.3 mm. Concomitant procedures were 
      atrial fibrillation (AF) ablation (19 patients) and tricuspid repair (17 
      patients). Follow-up was 100% complete (mean 4.2 +/- 2.5 years, median 4.2 years, 
      range 3.3 months-11.1 years). RESULTS: In-hospital mortality was 5.6%. Actuarial 
      survival at 6.5 years was 69 +/- 8.8%. Patients submitted to successful AF ablation 
      and/or cardiac resynchronization therapy (CRT) had a significantly better 
      survival (91 +/- 7.9 vs 67 +/- 9.5%, P = 0.01). Freedom from MR>/=3+/4+ was 89.1 +/- 5.7% 
      at 6.5 years. Follow-up echocardiography showed a reduction in LVEDD (P < 0.0001) 
      and LVESD (P = 0.0003). Mean EF increased to 38.7 +/- 12.4% (P < 0.0001). 
      Multivariate analysis identified successful ablation of AF and/or CRT (P = 0.01) 
      and higher preoperative EF (0.03) as predictors of overall survival. Successful 
      ablation of AF and/or CRT (P = 0.02) and lower preoperative systolic pulmonary 
      artery pressure (0.04) were identified as independent predictors of reverse LV 
      remodelling at follow-up. At last follow-up, 86.2% of the patients were in NYHA 
      II or less. CONCLUSIONS: Mitral repair for FMR in well-selected iDCM patients is 
      associated with low hospital mortality and significant clinical benefit at late 
      follow-up. Concomitant successful AF ablation and/or CRT provide a major 
      symptomatic and prognostic advantage and should be associated to mitral surgery 
      whenever indicated.
FAU - De Bonis, Michele
AU  - De Bonis M
AD  - Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy. 
      michele.debonis@hsr.it
FAU - Taramasso, Maurizio
AU  - Taramasso M
FAU - Verzini, Alessandro
AU  - Verzini A
FAU - Ferrara, David
AU  - Ferrara D
FAU - Lapenna, Elisabetta
AU  - Lapenna E
FAU - Calabrese, Maria Chiara
AU  - Calabrese MC
FAU - Grimaldi, Antonio
AU  - Grimaldi A
FAU - Alfieri, Ottavio
AU  - Alfieri O
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
DEP - 20120323
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 Oct;42(4):646-7. PMID: 22513852
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Atrial Fibrillation/complications/diagnostic imaging/therapy
MH  - Cardiac Resynchronization Therapy
MH  - Cardiomyopathy, Dilated/*complications/diagnostic imaging/mortality
MH  - Combined Modality Therapy
MH  - Follow-Up Studies
MH  - *Heart Valve Prosthesis Implantation/mortality
MH  - Hospital Mortality
MH  - Humans
MH  - Middle Aged
MH  - *Mitral Valve Annuloplasty/mortality
MH  - Mitral Valve Insufficiency/diagnostic imaging/etiology/mortality/*surgery
MH  - Multivariate Analysis
MH  - Retrospective Studies
MH  - Survival Analysis
MH  - Treatment Outcome
MH  - Ultrasonography
MH  - Ventricular Dysfunction, Left/complications/diagnostic imaging/mortality
EDAT- 2012/03/27 06:00
MHDA- 2013/03/09 06:00
CRDT- 2012/03/27 06:00
PHST- 2012/03/27 06:00 [entrez]
PHST- 2012/03/27 06:00 [pubmed]
PHST- 2013/03/09 06:00 [medline]
AID - ezs078 [pii]
AID - 10.1093/ejcts/ezs078 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2012 Oct;42(4):640-6. doi: 10.1093/ejcts/ezs078. Epub 
      2012 Mar 23.