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DOI: 10.1055/s-0030-1269198
Restrictive mitral valve annuloplasty for chronic ischemic mitral regurgitation: A 4-year clinical experience with the „Geoform Ring“
Objective: To analyse the results of restrictive mitral valve (MV) annuloplasty using the Geoform Ring (Edwards Geoform Annuloplasty Ring; Edwards Lifesciences LLC, Irvine, USA) concomitant to coronary artery bypass grafting (CABG) in patients with moderately severe to severe chronic ischemic mitral regurgitation (IMR) and advanced ischemic cardiomyopathy (ICM).
Methods: Forty consecutive elective patients (68±10 years) with chronic IMR grade 3–4 (3.5±0.5), left ventricular ejection fraction (LVEF) of 29±8% (range: 15–45%) and apical symmetric mitral leaflet tethering with central jet, underwent standardized restrictive prosthetic ring annuloplasty with downsizing of 1.3±0.7 ring-sizes (range: 0–2) using the Geoform Ring concomitant to CABG. Patients were restudied after 1 week, at 3 months and at 2 years to assess survival, New York Heart Association (NYHA) class, residual mitral regurgitation (MR), mitral orifice area (MOA), leaflet coaptation height (LCH), left atrial (LA) size and LV-function (end-systolic/end-diastolic dimensions/volume-indexes and LVEF).
Results: Survivals at time of reexamination were 95%, 95% and 93%, respectively. NYHA-class improved from 3.4±0.5 to 1.4±0.6 as well as all LA/LV-dimensions/volume-indexes and LVEF (p<0.001), which was 37±8% at 2 years follow-up. Residual MR 2 years after surgery was grade 0.6±0.6, postoperative recurrence of significant IMR (>grade 2) was absent in all patients. Further, enduring LCH (8±1mm) and adequate MOA (3.0±0.6cm2) could be documented.
Conclusion: Restrictive mitral valve annuloplasty using the Geoform Ring corrected chronic IMR in patients with advanced ICM with low mortality and improved contractility. Surgery also prevented recurrence of significant IMR in parallel with the phenomenon of postoperative continuous reverse myocardial remodelling.