Mitral annuloplasty with a flexible linear reducer

Ventricular remodeling and mitral valve modifications in dilated cardiomyopathy: new insights from anatomic study

OBJECTIVE

The purpose of this study was to analyze the behavior of the mitral valve ring and the left ventricle in dilated cardiomyopathy.

METHODS

We analyzed 68 fixed adult human hearts, divided into 48 hearts with dilated cardiomyopathy of ischemic or idiopathic origin and 20 hearts free of pathologic heart conditions. Digital images of the mitral ring perimeter, attachment of the anterior and posterior leaflets, and fibrous and muscular portions were collected. We also measured the internal perimeter of the left ventricle, the distance from the septum to the anterior and posterior papillary muscles, the distance between the papillary muscles, and the extension of interventricular septum.

RESULTS

The analysis of the results showed proportional distribution of the ring's fibrous portion (r2 = 0.98) and muscular portion (r2 = 0.99) according to the degree of mitral valve dilation. Linear regression revealed that the perimeters of anterior and posterior leaflet attachments (r2 = 0.96 and r2 = 0.98, respectively) also had a proportional relation. We did not observe proportionality between the degree of dilation of the mitral ring and the left ventricle. It was observed that dilation of the left ventricle takes place globally in its segments.

CONCLUSION

Differently from what was thought, in ischemic or idiopathic dilated cardiomyopathy, dilation of mitral ring is proportional and does not exclusively affect the posterior portion. The degree of left ventricular dilation does not determine the degree of dilation of the mitral ring because they are independent processes. These observations shed new light on the techniques used to correct mitral valve insufficiency in dilated cardiomyopathy.

Posterior mitral annuloplasty with a flexible linear reducer

OBJECTIVES

We evaluated posterior annuloplasty results using a flexible linear reducer, especially as a cardiac surgical procedure.

METHODS

Subjects were 24 patients consisting of 20 men and 4 women aged 7 to 79 years (mean; 61.3 years) with mitral regurgitation who underwent mitral valve reconstruction using a flexible linear reducer from May 1999 to April 2001. Mitral regurgitation was attributed to myocardial ischemia in 9 (37.5%). Isolated mitral valve repair was conducted only in 3 (12.5%) and concomitant procedures in 21 (87.5%).

RESULTS

No operative deaths occurred. One hospital death (4.2%) occurred due to cardiac failure on postoperative day 58. Four late deaths (16.7%) occurred 8 to 15 months after surgery due to heart failure, stroke, and cancer. No patients required reoperation and no perioperative complications occurred. Doppler echocardiography conducted in all patients within a month postoperatively showed excellent valve function: 11 (45.8%) had no residual regurgitation, 5 (20.8%) had trivial insufficiency, 6 (25%) had mild insufficiency, 2 (8.3%) had moderate insufficiency, and none had severe insufficiency. We observed significantly reducted enddiastolic and systolic left ventricular diameter while ejection fraction remained unchanged.

CONCLUSIONS

Posterior mitral annuloplasty using a flexible linear reducer is simple, saves time, and is useful for the small left atrium and as an additional procedure in other cardiac surgery.

Flexible posterior mitral annuloplasty: five-year clinical and Doppler echocardiographic results

BACKGROUND

Stabilization of the posterior annulus seems to be a critical factor to achieve a stable mitral valve repair. To assess the benefit of softer mural annuloplasty, we analyzed results obtained with the flexible linear reducer.

METHODS

From 1985 to 1993, 120 patients, with pure mitral regurgitation, mainly degenerative, had a mitral reconstruction. Mean age was 64+/-11 years and 74% of the patients were in New York Heart Association functional class III or IV.

RESULTS

Hospital mortality was 3.3%. Mean follow-up was 56+/-24 months. There were 23 late deaths; 10 valve-related including 7 sudden deaths. Two patients (1.7%) required a reoperation. Doppler echocardiographic studies revealed excellent valve function; 5-year freedom from significant regurgitation was 85.8%+/-5.4%. Mean mitral valve area was 2.76+/-0.77 cm2. Although 105 patients were in class I or II, 23 patients were not functionally improved. Previous myocardial infarction and shorter deceleration time of early filling were risk factors for worsening functional disability.

CONCLUSIONS

This support provides stable repair with excellent clinical and echographic results. Previous myocardial infarction and noncompliant left ventricle negatively influence outcome.