European Heart Journal Advance Access originally published online on November 7, 2007
European Heart Journal 2008 29(2):231-240; doi:10.1093/eurheartj/ehm468
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Five-year echocardiographic results of combined undersized mitral ring annuloplasty and coronary artery bypass grafting for chronic ischaemic mitral regurgitation
1 Experimental Surgery Unit, Department of Heart and Vessels, Careggi HospitalViale Morgagni 85, 50134 Florence, Italy
2 Cardiac Surgery Unit, Civic Hospital, Brescia, Italy
Received 30 April 2007; revised 30 August 2007; accepted 24 September 2007; online publish-ahead-of-print 7 November 2007.
* Corresponding author. Tel +39 055 794 7467, Fax: +39 055 794 7628, Email: sandro.gelsomino{at}libero.it
See page 147 for the editorial comment on this article (doi:10.1093/eurheartj/ehm531)
Aims: We present 5-year echocardiographic results of combined undersizing mitral ring annuloplasty (UMRA) and coronary artery bypass grafting (CABG) in chronic ischaemic mitral regurgitation (CIMR).
Methods and results: Two hundred and fifty-one patients (aged 68.4 ± 8.1, 62.5% male) undergoing combined CABG and UMRA in our Institution (Cardiac Surgery, Careggi Hospital, Florence, Italy) between September 2001 and March 2007 were prospectively enrolled in the study. Median follow up was 32.9 months [interquartile range (IQR) 17.5–51.6]. Fourteen patients with significant residual mitral regurgitation (MR) needing immediate intraoperative revision (n = 3) or at discharge (n = 11) were excluded from the study. Serial echocardiograms were performed in 220 survivors at baseline, discharge, and annually thereafter. Additionally, 17 patients died (2 early and 15 late deaths) and were also excluded from the study. MR remained stable at 1 year and re-increased at 3 years (P < 0.001) and 5 years (P < 0.001). Five-year actuarial survival was 83.2 ± 4.4. Five-year freedom from re-operation for failed repair was 78.2 ± 4.9%. Mean systolic and diastolic diameters decreased significantly at discharge (P = 0.001 and P = 0.01, respectively) and at early follow up (P = 0.004 and P = 0.02) but raised at 3 years (P < 0.001) and 5 years (P < 0.001). Systolic and diastolic sphericity indexes improved at discharge (P < 0.001) remained stable at 1 year but they re-increased at 3-year control (P = 0.006 and P = 0.03, respectively) with a late raise exceeding the pre-operative value (P < 0.001). Left ventricular reverse remodelling was observed in 44.2% of the study population with 10.3% of patients showing further left ventricular dilatation. At multivariable model, end-systolic volume 
145 mL, systolic sphericity index 0.7, myocardial performance index 0.9, and wall motion score index 1.5 were predictors of recurrent MR.
Conclusion: Our findings emphasize the need for improved repair technique and better patient selection to identify patients with anticipated repair failure who could benefit more from valve replacement or other procedure directly addressing ventricular tethering.
Key Words: Mitral valve • Mitral regurgitation • Mitral valve repair
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