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Three-dimensional valve repair-the better care? Midterm results of a saddle-shaped, rigid annuloplasty ring in patients with ischemic mitral regurgitation.
J Thorac Cardiovasc Surg 2014; 148(1):176-82JT

Abstract

OBJECTIVES

Undersized ring annuloplasty is the treatment of choice for functional mitral regurgitation. However, recurrence of mitral regurgitation within the first years is frequent. The aim of this study was to analyze the functional and clinical outcome after mitral valve repair with the 3-dimensional saddle-shaped Edwards GeoForm (Edwards Lifesciences LLC, Irvine, Calif) annuloplasty ring in patients with ischemic mitral regurgitation.

METHODS

Between November 2006 and November 2012, 70 patients (mean age, 68 ± 10 years; mean left ventricular ejection fraction, 40% ± 15%) with functional mitral regurgitation due to ischemic cardiomyopathy underwent mitral valve repair with the Edwards GeoForm annuloplasty ring. Concomitant procedures, such as coronary artery bypass grafting (75.7%), tricuspid valve repair (25.7%), aortic valve replacement (8.6%), and the Maze procedure (4.3%), were performed in 92.9% of patients. Follow-up is 97% complete (mean, 3.0 ± 1.7 years). Transthoracic echocardiography was obtained 2.4 ± 1.7 years postoperatively.

RESULTS

Thirty-day mortality was 5.9%. Overall survival at 5 years was 71.3% ± 6.9%. At 4 years, overall freedom from recurrence of mitral regurgitation grade 3+ or greater was 92.5% ± 3.6%, and freedom from recurrence of mitral regurgitation grade 2+ or greater was 71.0% ± 8.7%. Three patients required a mitral valve-related reoperation for ring dehiscence. New York Heart Association functional class improved from 3.6 ± 0.6 to 1.6 ± 0.6 during follow-up (P < .05). Mean mitral valve pressure gradient was 3.3 ± 1.8 mm Hg across all ring sizes at the time of follow-up.

CONCLUSIONS

Mitral valve repair with the 3-dimensional saddle-shaped Edwards GeoForm annuloplasty ring in case of ischemic mitral regurgitation shows a low rate of recurrent regurgitation at 4 years. Clinically relevant mitral stenosis was not detected. The importance of secure anchoring of the device in the mitral annulus has to be emphasized to prevent ring dehiscence.

Authors+Show Affiliations

Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany. Electronic address: guenzinger@dhm.mhn.de.Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.Institute of Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24176268

Citation

Guenzinger, Ralf, et al. "Three-dimensional Valve Repair-the Better Care? Midterm Results of a Saddle-shaped, Rigid Annuloplasty Ring in Patients With Ischemic Mitral Regurgitation." The Journal of Thoracic and Cardiovascular Surgery, vol. 148, no. 1, 2014, pp. 176-82.
Guenzinger R, Schneider EP, Guenther T, et al. Three-dimensional valve repair-the better care? Midterm results of a saddle-shaped, rigid annuloplasty ring in patients with ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2014;148(1):176-82.
Guenzinger, R., Schneider, E. P., Guenther, T., Wolf, P., Mazzitelli, D., Lange, R., & Voss, B. (2014). Three-dimensional valve repair-the better care? Midterm results of a saddle-shaped, rigid annuloplasty ring in patients with ischemic mitral regurgitation. The Journal of Thoracic and Cardiovascular Surgery, 148(1), pp. 176-82. doi:10.1016/j.jtcvs.2013.08.071.
Guenzinger R, et al. Three-dimensional Valve Repair-the Better Care? Midterm Results of a Saddle-shaped, Rigid Annuloplasty Ring in Patients With Ischemic Mitral Regurgitation. J Thorac Cardiovasc Surg. 2014;148(1):176-82. PubMed PMID: 24176268.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Three-dimensional valve repair-the better care? Midterm results of a saddle-shaped, rigid annuloplasty ring in patients with ischemic mitral regurgitation. AU - Guenzinger,Ralf, AU - Schneider,Eike Philipp, AU - Guenther,Thomas, AU - Wolf,Petra, AU - Mazzitelli,Domenico, AU - Lange,Ruediger, AU - Voss,Bernhard, Y1 - 2013/10/28/ PY - 2013/05/17/received PY - 2013/07/29/revised PY - 2013/08/22/accepted PY - 2013/11/2/entrez PY - 2013/11/2/pubmed PY - 2014/8/19/medline SP - 176 EP - 82 JF - The Journal of thoracic and cardiovascular surgery JO - J. Thorac. Cardiovasc. Surg. VL - 148 IS - 1 N2 - OBJECTIVES: Undersized ring annuloplasty is the treatment of choice for functional mitral regurgitation. However, recurrence of mitral regurgitation within the first years is frequent. The aim of this study was to analyze the functional and clinical outcome after mitral valve repair with the 3-dimensional saddle-shaped Edwards GeoForm (Edwards Lifesciences LLC, Irvine, Calif) annuloplasty ring in patients with ischemic mitral regurgitation. METHODS: Between November 2006 and November 2012, 70 patients (mean age, 68 ± 10 years; mean left ventricular ejection fraction, 40% ± 15%) with functional mitral regurgitation due to ischemic cardiomyopathy underwent mitral valve repair with the Edwards GeoForm annuloplasty ring. Concomitant procedures, such as coronary artery bypass grafting (75.7%), tricuspid valve repair (25.7%), aortic valve replacement (8.6%), and the Maze procedure (4.3%), were performed in 92.9% of patients. Follow-up is 97% complete (mean, 3.0 ± 1.7 years). Transthoracic echocardiography was obtained 2.4 ± 1.7 years postoperatively. RESULTS: Thirty-day mortality was 5.9%. Overall survival at 5 years was 71.3% ± 6.9%. At 4 years, overall freedom from recurrence of mitral regurgitation grade 3+ or greater was 92.5% ± 3.6%, and freedom from recurrence of mitral regurgitation grade 2+ or greater was 71.0% ± 8.7%. Three patients required a mitral valve-related reoperation for ring dehiscence. New York Heart Association functional class improved from 3.6 ± 0.6 to 1.6 ± 0.6 during follow-up (P < .05). Mean mitral valve pressure gradient was 3.3 ± 1.8 mm Hg across all ring sizes at the time of follow-up. CONCLUSIONS: Mitral valve repair with the 3-dimensional saddle-shaped Edwards GeoForm annuloplasty ring in case of ischemic mitral regurgitation shows a low rate of recurrent regurgitation at 4 years. Clinically relevant mitral stenosis was not detected. The importance of secure anchoring of the device in the mitral annulus has to be emphasized to prevent ring dehiscence. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/24176268/Three_dimensional_valve_repair_the_better_care_Midterm_results_of_a_saddle_shaped_rigid_annuloplasty_ring_in_patients_with_ischemic_mitral_regurgitation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(13)01068-4 DB - PRIME DP - Unbound Medicine ER -