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ASSA13-08-6 Suture Annuloplasty For the Surgical Treatment of Ishemic Mitral Regurgitation – the Long-Term Results
  1. Mikhail Gordeev,
  2. Alexey Maystrenko,
  3. Sergey Isakov,
  4. Irina Sukhova,
  5. Natalia Paskar,
  6. Alexander Gurshchenkov
  1. Alvazov Heart, blood and endocrinology centre, Saint - Petersburg, Russia

Abstract

Objective To assess the results of the suture annuloplasty for the treatment of ischemic mitral regurgitation (IMR).

Methods Sixty-four patients diagnosed with ischemic heart disease after myocardial infarction and mitral regurgitation (MR) were treated surgically between 2008 and 2011 in our centre. Medical records were reviewed retrospectively for clinical and echocardiographic data. The criterias of exception from research were replied left ventricle aneurism, organics reasons for MR, aortic valve replacement. CABG and mitral suture annuloplasty were perfomed in all cases. The mean quantity of distal anastomosis were 3.1 ± 0.5.

Results CABG and mitral suture annuloplasty in all cases were perfomed. All patients underwent clinical and echocardiographic follow-up at a mean follow-up period of 2.4 ± 1.31 years (median 2.7 years) Overall survival was 96.2 ± 6.6% at 3.8 years. We saw significant decrease of MR grade before and after the operation – from 3.2 ± 0.8 to 0.5 ± 0.4. At 3.5 years, overall freedom from MR ≥ 3+ was 91.1 ± 8% and freedom from MR ≥ 2+ was 75.1 ± 8.6%. There was significant decrease of of mitral annulus diametr from 37.3 ± 3.5 mm to 30.3 ± 5.5 mm (p < 0.001), without forming the mitral stenosis - peak transmitral gradients were before the operation 4.8 ± 3.1 mmHg and 5.5 ± 2.2 mmHg after, (p > 0.05). Reverse LV remodelling was demonstrated in 37 of the 64 patients eligible for this specific analysis (37/64, 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). But we didn’t see significant increase in ejection fraction increase after the 3.5 years of follow-up (49.9 ± 11.4% to 50.2 ± 11.3%, p > 0.05). The most of patient noticed the reduction of NYHA class of heart failure after the operation (2.8 ± 0.7 versus 0.8 ± 0.6, p < 0.001). Only 2 (3.1%) patients feel the chest pain after the surgery.

Conclusions The suture mitral annuloplasty is effective method of surgical correction of IMR. It improves reverse LV remodelling. Clinically relevant mitral stenosis was not detected. It tends to better clinical prognosis of chronic heart failure.

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