Functional mitral regurgitation in patients with ischemic cardiomyopathy undergoing surgical ventricular restoration for anterior aneurysm: echocardiographic findings and clinical impact

Objective: to evaluate clinical impact of severe functional mitral regurgitation(MR) in patients with dilatative post-ischemic CMP submitted to Surgical Ventricular Restoration(SVR). Methods: Among 445 consecutive patients operated of SVR for anterior aneurysm at our Institution between July 2001 and December 2011, 337(76%) patients presented with MR<2+(Group A,mean age 65±10yrs) while moderate to severe MR(3-4+) was evident in 108(24%) patients(Group B,mean age 64±9yrs;). LV volumes(p=.019), LV sfericity index(p=.004) and mitral tenting area(p=.005) resulted independent predictor of severe MR at presentation(Figure 1). Results: All patients underwent standard SVR with exclusion of antero-septal akinetic area. CABG was concomitantly performed in 414 patients(93%; mean number of graft=2.7±1.5). All patients in Group B underwent mitral annuloplasty; on the opposite, mitral repair was performed in 18 patients(5%) of GroupA, who presented with annular enlargement > 40mm. Thirty-days mortality was significantly higher in Group B(15%vs6%; p=.006). Seventy-five patients(22%) in Group A and 46 patients(43%) in Group B died at follow-up(p=.001). Kaplan-Meyer 5 and 10 years cumulative survival were significantly higher in group A(p=.008). Despite identical early mitral repair success rate, 15(7%) and 22(35%) patients in group A and B respectively(p=.001) showed long-term recurrence of severe MR. At Cox regression analysis preoperative mitral annulus dimension and postoperative systolic conicity index were the only independent predictors of late MR recurrence. Long-term 5 and 10 years survival(p=.037) as well as 5 and 10 years freedom from HF readmission(p=.001) were significantly affected by MR recurrence at FU. Conclusion: Severe preoperative MR significantly impacts surgical risk of SVR as early and long-term mortality. Furthermore, despite early succesfull surgical repair, severe MR recurrs in nearly a third of the discharged patients.