Forum ekspertów
Undersizing surgical mitral annuloplasty in patients with dilated cardiomyopathy – 12-month follow-up

Background:
Undersizing surgical mitral valvuloplasty is an
increasingly applied method of treatment in symptomatic patients (pts) with significant mitral regurgitation and dilated cardiomyopathy. We investigated the effects of undersizing surgical mitral or mitral and tricuspid valve repair on prognosis and quality of life in pts with idiopathic dilated cardiomyopathy and severe mitral regurgitation.

Material and methods:
27 pts (18 M, mean age 46.9±12.3 years) without coronary artery disease underwent surgical mitral valve repair. They were divided into 2 groups: group 1 – pts with undersizing mitral annuloplasty (n=17, Carpentier-Edwards Physio Ring, size 26-32); and group 2 – pts with undersizing mitral (n=10, Carpentier-Edwards Physio Ring size 26-30) and undersizing tricuspid annuloplasty: Carpentier-Edwards Classic Ring (3 pts), Duran Ring-Medtronic (6 pts), and de Vega methods (1 pt). In all the patients surgical treatment was followed by a 3-week rehabilitation programme. 30-day and 1-year mortality as well as clinical (New York Heart Association Class, quality-of-life
questionnaire) and echocardiographic variables at baseline and at mean follow-up of 22.8±9.5 months were assessed.

Results:
30-day mortality was 3.7% and 1-year mortality 11.1%. Postoperative assessment showed reduction of NYHA functional class (2.7±0.5, 1.7±0.5, p=0.001), pulmonary hypertension (45±4 vs. 35±10 mmHg, p=0.001) and left atrial size (left atrial area: 36±7 vs. 30±9 cm², p=0.05) and quality of life improvement (physical component summary: 33±7 vs. 41±7, p= 0.0001; mental component summary: 35±9 vs. 48±8, p=0.0003).
There were no significant differences between groups 1 and 2 with regard to clinical, echocardiographic and quality-of-life parameters.

Conclusions:
Undersizing surgical mitral valvuloplasty alone or combined with tricuspid annuloplasty in patients with idiopathic dilated cardiomyopathy results in improvement of clinical variables and quality of life. Selection criteria for patients who should benefit from this type of procedure are yet to be established.