Restrictive Mitral Valve Annuloplasty for Chronic Ischemic Mitral Regurgitation: A 5-Year Clinical Experience with the Physio Ring

摘要

The effects of surgery on myocardial and valvular function are still incompletely understood in patients with both advanced ischemic cardiomyopathy (ICM) or dilated cardiomyopathy (DCM) and chronic mitral regurgitation (MR). Whenever severe left ventricular (LV) dysfunction is etiogenic for chronic MR, mitral valve (MV) annuloplasty in a "restrictive" (ie, undersized/"downsized") fashion has been proposed as a reliable approach for efficiently correcting MR [Boiling 1995; Bax 2004; Geidel 2005]. However, some of the difficulty in assessing the results of this strategy may lie in the variety of surgical techniques applied (eg, regarding the type of ring material used for annuloplasty), and some other difficulties may lie in the different characteristics of valvular and myocardial pathology. At present, it is still unclear why some patients experience progressive deterioration of myocardial function and secondary recurrent MR consequent to a process of continuous myocardial remodeling, even if an "established" surgical strategy of MV repair has been applied. Our study investigates the early and late results of using a standardized approach of downsizing the MV annulus by 2 to 4 ring sizes with the Carpentier-Edwards Physio ring (Edwards Lifesciences, Irvine, CA, USA), which is a semirigid 2-dimensional ring-shaped device for correcting myocardial function in patients with advanced ICM and moderately severe to severe chronic ischemic MR (IMR) (grades 3-4). We describe a 5-year clinical experience in surgery and relevant postoperative changes with respect to myocardial and valvular function for 100 consecutive patients. We also provide a detailed presentation of the clinical follow-up data.