Jerry Braun, Jos J. Westenberg, Nico R. van de Veire, Stijntje D. Roes, Rob J. van der Geest, Albert de Roos, Ernst E. van der Wall, Johan H. Reiber, Jeroen J. Bax, Robert A. Dion; Leiden University Medical Center, Leiden, Netherlands
Objective: Restrictive annuloplasty is the preferred surgical technique for non-ischemic, dilated cardiomyopathy with severe mitral regurgitation. Left atrium (LA) and ventricle (LV) show early reverse remodeling after surgery. The long-term outcome however, has been debated. In this study, the long-term outcome (3-4 years) was studied using MRI.Methods: Twenty-two patients (mean age 57±15 years) with mild heart failure (mean NYHA class 2.2±0.4, LV ejection fraction (EF) between 25% and 45%), dilated cardiomyopathy (end-diastolic dimension <65mm) and severe mitral regurgitation (grade 3-4+, mean 3.6±0.5, secondary to LV and annular dilatation and systolic restrictive motion of mitral leaflets) underwent restrictive mitral annuloplasty (median ring size 26, aiming at undersizing of 2 ring sizes). MRI and echocardiography were performed within one week pre-surgery. Three to four years after surgery, survivors underwent follow-up imaging (mean 43±8 months; range 32 to 58 months).
Results: During follow-up, two patients died (9%); all surviving patients were free from endocarditis and thrombo-embolism. NYHA class improved from 2.2±0.4 to 1.2±0.4. One patient developed recurrent severe mitral regurgitation and underwent repeat surgery. Two other patients could not undergo follow-up MRI due to non-cardiac related events. The remaining 18 patients underwent the second MRI and echo examinations. At follow-up, mitral regurgitation on echocardiography was minimal (all patients =grade 2+). LA end-systolic volume (ESV) indexed by body surface area (BSA) decreased significantly over time (from 84±20 ml/m2 to 68±12 ml/m2, p<0.01). LA end-diastolic volume (EDV) indexed by BSA did not show significant decrease (from 48±16 ml/m2 to 44±10 ml/m2, p=0.15). LVESV indexed by BSA decreased significantly (from 42±14 ml/m2 to 31±12 ml/m2, p<0.01), as did LVEDV indexed by BSA (from 110±18 ml/m2 to 80±17 ml/m2, p<0.01). LVEF (corrected for mitral regurgitation) increased significantly (from 37±5% to 55±10%, p<0.01) and LV mass indexed by BSA decreased significantly (from 76±21 g/m2 to 66±12 g/m2, p=0.03).
Conclusion: Long-term outcome of restrictive annuloplasty in patients with mild heart failure, dilated cardiomyopathy and severe mitral regurgitation was good and significant LA and LV reverse remodeling was sustained.
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