TITLE

The GeoForm annuloplasty ring for the surgical treatment of functional mitral regurgitation in advanced dilated cardiomyopathy

AUTHOR(S)
De Bonis, Michele; Taramasso, Maurizio; Grimaldi, Antonio; Maisano, Francesco; Calabrese, Maria Chiara; Verzini, Alessandro; Ferrara, David; Alfieri, Ottavio
PUB. DATE
August 2011
SOURCE
European Journal of Cardio-Thoracic Surgery;Aug2011, Vol. 40 Issue 2, p488
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Abstract: Objective: To assess the results of the three-dimensional (3D)-shaped GeoForm ring for the treatment of functional mitral regurgitation (FMR). Methods: Seventy-four patients with severe FMR and systolic dysfunction underwent GeoForm ring implantation. Forty-six patients (62%) were in the New York Heart Association (NYHA) class III–IV. Concomitant procedures were coronary artery bypass grafting (CABG) (33 patients (pts)), tricuspid repair (23 pts), atrial fibrillation ablation (20 pts), aortic valve replacement (eight pts) and left-ventricular (LV) reconstruction (five pts). Results: Hospital mortality was 9%. Three more patients died after hospital discharge. Overall survival was 81.1±6.6% at 3.5 years. The 67 hospital survivors underwent clinical and echocardiographic follow-up at a mean follow-up period of 1.9±1.25 years (median 1.7 years). MR was absent or mild in 83% of the patients (56/67), moderate in 7% (5/67), and moderate to severe in the remaining 9% (6/67). At 3.5 years, overall freedom from MR≥3+ was 85.1±8% and freedom from MR≥2+ was 75.1±8.6%. Statistical analysis identified preoperative asymmetric tethering with prevalent restricted motion of the posterior leaflet as the only predictor of recurrence of MR≥2+ (hazard ratio (HR) 6.1, p =0.005). Reverse LV remodeling was demonstrated in 31 of the 54 patients eligible for this specific analysis (31/54, 57%): Both LV end-diastolic and end-systolic volumes indexed significantly decreased (both p =0.0001) as well as systolic pulmonary artery pressure (SPAP) (p =0.006). Ejection fraction increased from 33±8% to 43±8% (p <0.0001). Stress echocardiography was performed in a subgroup of eight patients. Mean mitral area at rest was 2.2±0.3cm2 and did not change during stress. Cardiac output significantly increased in all patients during exercise. Although mean and peak transmitral gradients were 3.3±1.3 and 8.1±2.2mmHg at rest and 6.6±2.5 and 14.8±3.9mmHg under stress, respectively (both p <0.003), the increase in SPAP was not statistically significant (28±3.0 vs 31±7.5mmHg, p =0.17), revealing a preserved cardiac adaptation to exercise. Conclusions: The GeoForm ring is effective in relieving FMR in most of the patients with dilated cardiomyopathy. In presence of prevalent restricted motion of the posterior leaflet, recurrence of significant MR is more likely to occur. Clinically relevant mitral stenosis was not detected during exercise.
ACCESSION #
62844812

 

Related Articles

  • Re-operations for aortic allograft root failure: experience from a 21-year single-center prospective follow-up study Bekkers, Jos A.; Klieverik, Loes M.A.; Raap, Goris Bol; Takkenberg, Johanna J.M.; Bogers, Ad J.J.C. // European Journal of Cardio-Thoracic Surgery;Jul2011, Vol. 40 Issue 1, p35 

    Abstract: Objective: The study aims to report results of re-operations after aortic allograft root implantation. Methods: All consecutive patients in our prospective allograft database, who underwent aortic allograft root implantation, were selected for analysis, and additional information for...

  • Aortic root enlargement does not increase the surgical risk and short-term patient outcome? Coutinho, Gonçalo F.; Correia, Pedro M.; Paupério, Gonçalo; de Oliveira, Ferrão; Antunes, Manuel J. // European Journal of Cardio-Thoracic Surgery;Aug2011, Vol. 40 Issue 2, p441 

    Abstract: Objective: To analyze the short-term outcome of aortic root enlargement (ARE) using death and adverse events as end points. Methods: From January 1999 through December 2009, 3339 patients were subjected to aortic valve replacement (AVR). A total of 678 were considered to have small...

  • Midterm outcome after aortic root replacement with stentless porcine bioprostheses. Ennker, Ina C.; Albert, Alexander; Dalladaku, Fatmir; Rosendahl, Ulrich; Ennker, Juergen; Florath, Ines // European Journal of Cardio-Thoracic Surgery;Aug2011, Vol. 40 Issue 2, p429 

    Abstract: Objective: Midterm clinical outcome was evaluated after aortic root replacement with Freestyle® stentless aortic root bioprostheses. Methods: Between April 1996 and December 2007, 301 patients underwent aortic valve replacement with stentless Medtronic Freestyle® bioprostheses in...

  • Freedom SOLO valve: early- and intermediate-term results of a single centre's first 100 cases. Oses, Pierre; Guibaud, Jean-Philippe; Elia, Nicolas; Dubois, Gilbert; Lebreton, Guillaume; Pernot, Mathieu; Roques, Xavier // European Journal of Cardio-Thoracic Surgery;Feb2011, Vol. 39 Issue 2, p256 

    Abstract: Objective: The Freedom SOLO aortic valve is a bovine pericardial stentless valve, which requires only one suture line. The aim of our single-centre retrospective study was to assess postoperative and intermediate-term haemodynamic results of the first 100 consecutively implanted...

  • Abrupt formation of intracardiac thrombus during cardiopulmonary bypass with full heparinization -A case report-. Seong-Hyop Kim; Jae-Sung Ryu; Tae-Yop Kim; Tae-Gyoon Yoon; Woonseok Kang; Ji Eun Song // Korean Journal of Anesthesiology;Feb2012, Vol. 62 Issue 2, p175 

    Intracardiac thrombus during cardiopulmonary bypass (CPB) with full heparinization is very rare but fatal. A 60-year-old woman was scheduled for aortic and mitral valve repairs with a maze procedure for mixed aortic and mitral valvular heart disease with atrial fibrillation. Preoperative...

  • Long-term effect of papillary muscle approximation combined with ventriculoplasty on left ventricle function in patients with ischemic cardiomyopathy and functional mitral regurgitation. Mandegar, Mohammad Hossein; Saidi, Bahare; Yousefnia, Mohammad Ali; Alaeddini, Farshid; Roshanali, Farideh // European Journal of Cardio-Thoracic Surgery;Sep2011, Vol. 40 Issue 3, p756 

    Abstract: Objective: One of the mechanisms of development of functional mitral regurgitation after myocardial infarction is the increased papillary muscle distance which results due to ventricle remodeling. The aim of this study was to investigate the long-term effect of papillary muscle...

  • New Replacement of a Thrombosed Mitral Valve via Right Anterolateral Thoracotomy in a Patient with Coronary Artery By-Pass Graft and Functioning Internal Mammary Artery Graft. Cevız, Münacettin; Becıt, Necip; Erkut, Bilgehan; Koçak, Hikmet // Turkish Journal of Medical Sciences;2007, Vol. 37 Issue 6, p377 

    A 49-year-old male, who had undergone mitral valve replacement with mechanical cardiac valve and coronary arterial by-pass grafting six years previously, was admitted to our hospital with acute dyspnea. Transesophageal echocardiography revealed that one of the leaflets of the prosthetic valve...

  • Should root replacement with aortic valve-sparing be offered to patients with bicuspid valves or severe aortic regurgitation? Badiu, Catalin Constantin; Eichinger, Walter; Bleiziffer, Sabine; Hermes, Grit; Hettich, Ina; Krane, Markus; Bauernschmitt, Robert; Lange, Rüdiger // European Journal of Cardio-Thoracic Surgery;Nov2010, Vol. 38 Issue 5, p515 

    Abstract: Objective: To examine the results of root replacement with aortic valve-sparing in patients with bicuspid aortic valve (BAV) or severe aortic regurgitation (AR). Methods: Between 2000 and 2009, 102 patients (mean age 47±17.5 years) underwent aortic valve-sparing procedures for...

  • Apical-access-related complications associated with trans-catheter aortic valve implantation. Bleiziffer, Sabine; Piazza, Nicolo; Mazzitelli, Domenico; Opitz, Anke; Bauernschmitt, Robert; Lange, Rüdiger // European Journal of Cardio-Thoracic Surgery;Aug2011, Vol. 40 Issue 2, p469 

    Abstract: Objective: The left-ventricular trans-apical access has become well established for trans-catheter aortic valve implantation, especially for patients in whom a retrograde trans-arterial implantation is contraindicated. We report on the short- and long-term implications of the...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics