Back to Annual Meeting Posters

OBJECTIVES: Functional mitral regurgitation in patients with chronic ischaemic cardiomyopathy denotes abnormal function of normal leaflets due to left ventricular enlargement and leaflets tethering. We present the mid-term results of a new approach to mitral repair using a combination of the following subvalvular procedures: 1) reimplant of basal chordae on the free edge of the anterior leaflet (“cut and transfer” technique), 2) relocation of the posterior papillary muscles closer to the mitral annulus. 3) plication of the postero-lateral wall of the left ventricle.
METHODS: From 2008 to 2011, 46 patients with moderate to severe ischemic mitral regurgitation underwent CABG + mitral valve repair using the “cut and transfer” technique for the anterior leaflet and papillary muscle relocation for the posterior leaflet. All the patients received a “true-sized”, complete, rigid annuloplasty ring. In 20 patients with severely dilated LV a plication of the postero-lateral wall of left ventricle was performed in order to reduce the LV diastolic diameter and therefore the tethering of the mitral leaflets.
RESULTS: The mean number of coronary artery bypass grafts was 2.4 ± 0.4. Hospital mortality was 2.4%. No patient died during one year follow-up and NYHA class improved from 3.4±0.5 to 1.4±0.6, p<0.005. The 1-year TTE showed the following changes from the baseline: MR grade (0-4) 2.9±0.4 vs 0.2±0.4, p<0.005. LVESVI (ml/m2) 52.7±13.1 vs 48.2±10.1, p=ns. LVEDVI (ml/m2) 92.9±16.5 vs 83.4±15.9, p<0.025. EF (%) 37.8±6.3 vs 44.2, p<0.005.
CONCLUSIONS: Both clinical and echocardiographic follow-up show that reducing the tethering of the mitral leaflets with tailored interventions on subvalvular apparatus without undersizing the mitral annulus can effectively correct functional mitral valve regurgitation in patients with ischaemic cardiomyopathy.