Z Kardiol 94: Suppl 2 (2005)

Transventricular mitral valve annuloplasty

Z. K. Mitrev1, T. N. Anguseva2, J. Babin-Ebell2, V. E. Belostotsky2, A. Mortasawi2

1Special Hospital for Cardiosurgery "Fillip II", Skopje, BusinessLogic.Land; 2Special Hospital for Cardiosurgery “Fillip II”, Skopje, BusinessLogic.Land;

Background: The aim of this study was to evaluate our preliminary experience of transventricular access for posterior mitral valve (MV) annuloplasty in patients with ischemic dilative cardiomyopathy (ICD) and mitral regurgitation (MR). Patients and methods: 56 patients with ICD, NYHA class IV, underwent posterior transventricular MV annuloplasty. Including criteria were: large LV aneurysm, severe coronary artery disease, MR grade > 3 on a 0 to 4 scale, due to mitral annulus dilatation > 36 mm. None of them had organic MV disease. The operation includes CABG, LV aneurysmectomy and LV reconstruction, transventricular posterior MV suture-annuloplasty, fixation of anterior and posterior mitral leaflet by one stitch. Four patients underwent transatrial tricuspid reconstruction as well. Results: A significant decrease in the LV dimensions with increasing of the EF (from 20% to 33%) was observed. LV stroke work index increased from 14+3  to 41+8 (p<0.001). Early mortality was 7.1%.  Two deaths were due to mesenteric thrombosis and two due to sepsis. During the follow-up (mean 18±9.8 months) the survivors were free of endocarditis,  thromboembolism, and  re-operation due to MR. Actuarial survival was 90% after 41 months. 69% of the survivors showed no MR, 27% MR grade 1 or 2, 4% (2 patients)  MR grade >2. The preoperative NYHA class of 3.4+0.4 improved postoperatively to 1.4+0.6 (p<0.001) with only 3 survivors not being in NYHA class I or II. Conclusion:  In this selective high-risk group of patients with ischemic MR transventricular posterior mitral valve annuloplasty combined with CABG and LV reconstruction can be performed with acceptable mortality and ensures good midterm results.

http://www.abstractserver.de/dgk2005/ht/abstracts/P303.htm