Selective Treatment Algorithm for Mitral Valve Annuloplasty in Nonischemic Functional Mitral Regurgitation

Background: The success rate of mitral annuloplasty (MA) for functional mitral regurgitation (FMR) varies. This study evaluated the effectiveness of this procedure in nonischemic dilated cardiomyopathy (DCM) patients after a selective treatment protocol was followed. Methods and Results: This study analyzed 42 patients with nonischemic DCM and FMR (mean regurgitation grade, 3.6 ± 0.3), aged a mean 56.5 ± 15 years (range, 25 to 78 years), who underwent MA from April 2003 to December 2007. The analysis excluded patients with coronary artery disease, or mitral leaflets or subvalvular pathologies. All patients had taken maximal medications for at least 3 months and were still in New York Heart Association (NYHA) functional class III to IV (mean, 3.2 ± 0.4). Mean ejection fraction (EF) was 31.4% ± 12.9% (range, 8% to 58%), and left ventricular end-diastolic diameter (LVEDD) was 66.0 ± 8.3 mm (range, 55 to 85 mm). Downsized Carpentier Physio ring (Carpentier-Edwards, Irvine, California) annuloplasty, mean size 26.3 ± 2.3 (range, 24 to 30), was the preferred procedure. Concomitant procedures included 23 tricuspid valve repairs and 10 Maze operations for atrial fibrillation. Echocardiography was performed at early (≤3 months; mean 1.6 ± 1.5), short-term (6 to 12 months; mean 6.9 ± 3.4), and midterm (>12 months; mean 29.5 ± 13.4 months) follow-up. All late deaths and readmissions were recorded. One (2.4%) in-hospital death occurred due to low cardiac output. Follow-up was completed in 40 of 41 (97.6%) patients (mean duration, 31.9 ± 16.1; range, 3.9 to 59.2 months). Eight (19.5%) patients were readmitted for heart failure, including 2 late MRs due to ring dehiscence and infective endocarditis. Three of 5 deaths during the follow-up period were attributed to cardiac death. Actuarial survival after 1 and 3 years was 88.9% and 79.2%, respectively. The number of patients treated with β-blockers increased after operation, from 52.4% to 75.6% (P = .028). NYHA class decreased from 3.2 ± 0.4 to 1.3 ± 0.6 (P < .0001). Echo examination revealed left heart reverse remodeling and improved performance in all follow-up time frames. Conclusion: This study shows that MA in patients with non-ischemic DCM and FMR is feasible and associated with reasonable short and long term outcomes.