Restrictive mitral valve annuloplasty for chronic mitral regurgitation in patients with cardiomyopathy using 2- and 3-dimensional-shaped ring-devices

Objective: The results of restrictive mitral valve (MV) annuloplasty for chronic mitral regurgitation (MR) in patients with advanced cardiomyopathy (CM) using 2-dimensional (2D) and 3-dimensional (3D) shaped prosthetic ring-devices are analysed.

Methods: Since 2001 two-hundred and twenty-one consecutive patients (age: 68±9 years) with chronic moderately severe to severe MR (grade 3–4) and advanced CM with left ventricular ejection fraction (LVEF) of 31±9% (range: 11–45%) underwent restrictive mitral annuloplasty using 2D- (n=176, downsizing of 2–4 ring-sizes) or 3D-shaped prosthetic ring-material (n=45, downsizing of 0–2 sizes). Patients were restudied 1 week, 3 months and 2.5 years after surgery to assess survival, residual MR, New York Heart Association (NYHA) functional class, mitral orifice area (MOA) and LV-function (end-systolic/end-diastolic dimensions/volume-indexes and LVEF).

Results: Hospital mortality was 2.3% (5 early cardiac deaths), the survival-rate at 3 months and 2.5 years was 96% and 93%, respectively. NYHA functional class improved significantly after surgery (from 3.4±0.5 to 1.5±0.6, p<0.001) as well as LV-dimensions/volume-indexes and LVEF (p<0.001; LVEF at 2.5 years follow-up was 38±10%). Late after surgery 88% of patients had MR grade 0–1, 12% had residual MR grade 2–3. Compared with restrictive annuloplasty using 2D-shaped ring-material, 3D-rings preserved significantly larger residual MOA after surgery (3.1±0.8cm² vs. 2.8±0.6cm², p<0.001). A prediction of continuous postoperative reverse remodeling could be demonstrated particularly for chronic ischemic etiology of MR/CM and concomitant coronary artery bypass grafting (p<0.001).

Conclusion: In mitral patients with advanced CM restrictive MV-annuloplasty using 2D- or 3D-shaped prosthetic ring-material corrected chronic MR with low mortality and significantly improved contractility.