Long-term outcomes after coronary artery bypass graft with or without surgical ventricular reconstruction in patients with severe left ventricular dysfunction.

Background:Patients with chronic myocardial infarction (MI) and severe left ventricular (LV) dysfunction have poor clinical outcomes. This study aimed to determine whether coronary artery bypass graft (CABG) with surgical ventricular reconstruction (SVR) leads to further improvement in long-term patient outcomes compared with isolated CABG (I-CABG).Methods:From April 2010 to June 2013, 140 consecutive patients with chronic MI and severe LV dysfunction who received contrast-enhanced cardiovascular magnetic resonance imaging (CE-CMR) within 1 month before surgery were enrolled in this study. The cardiovascular events (CVEs) and long-term survival of patients who underwent CABG and SVR were compared with those who met the criteria for SVR but received I-CABG.Results:A total of 140 patients were included in the final analysis, including 70 patients who underwent CABG and SVR and 70 patients who underwent I-CABG. No differences were observed in the baseline characteristics, LV function, and late gadolinium enhancement (LGE) between the two groups. CABG+SVR patients experienced a longer cardiopulmonary bypass (CPB) time (116.0±35.0 vs. 100.2±23.8 minutes, P=0.002) and ventilation time [median (interquartile range): 22.0 (17.0, 37.0) vs. 20.0 (15.0, 24.0) hours, P=0.019] than I-CABG patients. During a mean follow-up of 123.1±12.7 months (range, 102-140 months), the CABG+SVR group had fewer rehospitalizations for congestive heart failure (CHF) (4.3% vs. 19.1%, P=0.007), but no statistical difference in the mortality rate was observed (2.9% vs. 4.4%, P=0.987). The cumulative CVE-free survival rate was significantly higher in CABG+SVR patients (87.0% vs. 67.6%, P=0.007).Conclusions:Our findings indicated that patients with chronic MI and severe LV dysfunction experienced similar perioperative outcomes after CABG+SVR or I-CABG. However, the CABG+SVR group resulted in fewer rehospitalizations for CHF and a higher cumulative CVE-free survival rate.

Effects of left atrial appendage surgical treatment on the incidence of ischemic cerebrovascular accidents in patients with atrial fibrillation undergoing cardiac surgery.

BACKGROUND:We sought to assess different surgical methods for left atrial appendage treatment to determine whether any could reduce the incidence of atrial fibrillation-related long-term ischemic cerebrovascular accidents.METHODS:A total of 1243 patients were treated with left atrial appendage removal, and 107 patients (8.6%) were lost to follow-up and excluded. The primary outcome was the long-term incidence of ischemic cerebrovascular events (ie, ischemic stroke, excluding transient ischemic attack) and all-cause mortality.RESULTS:Of the 1136 patients, 37 (3.3%) had ischemic cerebrovascular events. The 1-year, 5-year, and 10-year freedoms from long-term ischemic cerebrovascular events of the left atrial appendage extracardiac ligation group were 99.7%, 94.0%, and 90.8%, respectively. The 1-year, 5-year, and 10-year survivals of the left atrial appendage intracardiac suture group were 99.7%, 94.6%, and 93.6%, respectively. There was a significant difference between the left atrial appendage extracardiac ligation group and the left atrial appendage excision group (P = .041). Seventeen patients (4.6%) had long-term ischemic cerebrovascular events in the left atrial appendage extracardiac ligation group (1.1% per year), 14 patients (3.5%) in the left atrial appendage intracardiac suture group (0.9% per year), and 6 patients (1.7%) in the left atrial appendage excision group (0.44% per year). Left atrial appendage excision can reduce the occurrence of long-term thrombotic stroke compared with left atrial appendage extracardiac ligation (95% confidence interval, 1.09-9.26; P = .035).CONCLUSIONS:For patients with atrial fibrillation, the removal of the left atrial appendage can effectively prevent stroke caused by atrial fibrillation.

Risk Factors for Aortic Regurgitation Progression After Repair of Sinus of Valsalva Aneurysm.

BACKGROUND:The main treatment for a ruptured sinus of Valsalva aneurysm (SVA) is surgical repair. Postoperative progression of aortic regurgitation (AR) following SVA repair increases the risk of reoperation, which decreases the long-term survival. Thus, identifying the risk factors for postoperative AR progression is of great significance.METHODS:Adult patients who were diagnosed with ruptured SVA and underwent surgical repair at the current centre were reviewed. Necessary data in the institutional database were extracted. The perioperative and follow-up assessments of the aortic valve by transthoracic echocardiography were also obtained. The aortic regurgitation progression was grouped into three categories: newly developing, recurrence, and worsening. Sixteen (16) variables were screened to identify potential risk factors by univariate logistic regression analysis or Chi-squared test. Variables with p-values <0.1 were further analysed by multivariate logistic regression models to find independent risk factors.RESULTS:A total of 198 consecutive patients from June 2006 to January 2018 were included. The overall incidence of postoperative AR progression was 19.2% (38 of 198). After the univariate analysis, SVA originating from the right coronary sinus, coexisting with ventricular septal defect, larger diameter of aortic annulus, and larger cardiothoracic ratio were screened as potential risk factors. Multivariate analysis indicated that coexisting with a ventricular septal defect (VSD) (OR, 2.82; 95% CI, 1.217-6.532; p=0.016) and larger cardiothoracic ratio (OR, 1.061; 95% CI, 1.001-1.124; p=0.047) were independent risk factors for postoperative AR progression.CONCLUSIONS:To prevent postoperative AR progression after surgical repair, more careful inspection and appropriate surgical techniques are necessary for patients coexisting with VSD or with a larger cardiothoracic ratio.

The enlargement rate of ventricular septal rupture is a risk factor for 30-day mortality in patients with delayed surgery.

BACKGROUND:Postinfarction ventricular septal rupture (VSR) is an uncommon but challenging mechanical complication for surgeons. This study analyzed the impacts of rupture size on surgical outcomes in patients with VSR.METHODS:During a 15-year period, from January 2006 to December 2020, 112 patients underwent repairs of postinfarction VSR. Patient clinical data, including angiographic and echocardiographic findings, operative procedures, early morbidity and mortality, and survival time were collated. Univariable and multivariable analyses were performed to identify the risk factors of 30-day mortality.RESULTS:The 30-day mortality rate was 7.1% for the whole cohort. The mean survival time estimate was 147.2 months [95% confidence interval (CI): 135.6 to 158.9 months], with a 3-year survival rate of 91.2% and a 5-year survival rate of 89.0%. Multivariable analysis revealed that rupture enlargement rate is an independent risk factor of 30-day mortality. The receiver operating characteristic (ROC) curve indicated that the rupture enlargement rate could predicted the 30-day mortality with high accuracy.CONCLUSIONS:Delayed surgery may be considered for patients who respond well to aggressive treatment. The rupture enlargement rate is an independent risk factor for postoperative 30-day morality in patients with delayed VSR repair. Furthermore, the rupture enlargement rate has good predictive value for the prognosis of VSR patients.

Prognostic value of myocardial scar by magnetic resonance imaging in patients undergoing coronary artery bypass graft.

BACKGROUND:Previous studies demonstrated that scar tissue assessed by late gadolinium enhancement cardiovascular magnetic resonance imaging (LGE-CMR) is associated with recovery of cardiac function after coronary artery bypass graft (CABG) in patients with a history of myocardial infarction (MI). However, information on the association between myocardial scar at baseline and long-term survival after CABG in these patients is lacking.METHODS:From April 2010 to May 2013, consecutive patients with multivessel coronary artery disease (CAD, > 70% stenosis in ≥2 vessels) and MI (> 3 months) who underwent LGE-CMR within 1 month prior to isolated CABG were enrolled. Left ventricular functional parameters and scar tissue were assessed by LGE-CMR before surgery. A standard 17-segment model was used for scar quantification. Predictors for cardiovascular events (CVEs) were analyzed.RESULTS:Of 148 patients who met the study inclusion/exclusion criteria, 140 cases had follow-up data and were included in final analysis. Of the latter, 27 (19.3%) patients suffered CVEs perioperatively or during mean 89.6 ± 12.0 months follow-up. In Cox proportional hazard regression model, the most significant predictor for CVEs after CABG was the number of scar segments on LGE-CMR (Hazard ratio 2.078, 95% Confidence Interval 1.133-3.814, P= 0.018). In Receiver-Operator-Characteristic (ROC) analysis, number of scar segments ≥6 predicted CVEs (sensitivity, 74.1%; specificity, 95.6%; area under the curve [AUC] = 0.934, P < 0.001).CONCLUSIONS:Scar tissue identified by LGE-CMR appears to be an independent predictor of CVEs after CABG in patients with a history of MI, which might allow preoperative risk stratification.

Extracardiac Tricuspid Annuloplasty: A Novel Technique for Functional Tricuspid Regurgitation.

We report 3 cases of functional tricuspid regurgitation and demonstrate a novel tricuspid repair technique through the right atrioventricular groove without cardiopulmonary bypass or open heart surgery, which provides a new idea for the treatment of functional tricuspid regurgitation.

Surgical results and pathological analysis of cardiac fibroma in the adolescent and the adult.

BACKGROUNDS:Disparities may exist between the adolescent and the adult patients with cardiac fibromas in the symptoms, surgical outcomes, and pathological characteristics. The aim of this study was to compare short and midterm surgical outcomes of cardiac fibromas and to compare the biomarker expressions of tumor tissue samples between the adult and the adolescent.METHODS:Consecutive patients with the diagnosis of cardiac fibroma were admitted and received surgeries. Primary outcomes included in-hospital mortality, low cardiac output, and readmission due to heart failure. The expression of PCNA and Ki67, two widely adopted indicators of cell proliferation, were evaluated in tissue samples.RESULTS:A total of five adolescent patients and five adult patients diagnosed as cardiac fibroma were admitted and given surgeries. When compare with the adults, the adolescent patients were more likely to present symptoms on admission (P = .048). Postoperative low cardiac output syndrome was significantly higher in the adolescents than in the adults (80.0% vs 0.0, P = .048). The tumor volume relative to ventricular end diastolic diameter had good discriminative ability for low cardiac output (c statistics: 0.96). Pathologically, the percentage of PCNA-positive cell nuclei was significantly higher in the adolescents than in the adults (36.04% ± 10.54% vs 4.15% ± 3.93%, P = .001). However, there were no Ki67-positive nuclei in the 10 cases.CONCLUSIONS:In the current study, we found that postoperative low cardiac output was more likely to occur in the adolescent patients than in the adult patients. When compared with the adult patients, significantly more PCNA-positive nuclei were observed in the adolescents.

Subannular repair for moderate to severe ischemic mitral regurgitation: Still a long way to go. Authors' reply.

Long-term outcomes of mitral valve annuloplasty versus subvalvular sparing replacement for severe ischemic mitral regurgitation.

BACKGROUND:Although practice guidelines recommend surgery for patients with severe chronic ischemic mitral regurgitation (CIMR), they do not specify whether to repair or replace the mitral valve. The purpose of this study was to evaluate the long-term outcomes in patients with severe CIMR undergoing mitral valve annuloplasty (MVA) versus subvalvular sparing mitral valve replacement (MVR).METHODS:392 consecutive patients who underwent MVA or subvalvular sparing MVR for treatment of severe CIMR were retrospectively reviewed.RESULTS:After adjustment for baseline differences with multivariable regression analysis at 53 months follow-up (interquartile range, 34-81 months), there was no significant difference between the two groups for risk of major adverse cardiac or cerebrovascular events (MACCE), cardiac death, or all-cause death. Propensity score matching extracted 77 pairs. During the follow-up, compared with the MVR group, both the left atrium and left ventricle end-diastolic diameter were markedly larger (p = 0.013 and p = 0.033, respectively), and the incidence of mitral regurgitation recurrence was significantly higher in the MVA group (p < 0.001). No significant difference was observed between the two propensity score-matched groups in composite in-hospital outcomes, overall survival, freedom from cardiac death or MACCE, except subvalvular sparing MVR was associated with a lower incidence of hospitalization for heart failure than MVA (p = 0.015).CONCLUSIONS:Subvalvular sparing MVR is a suitable management of patients with severe CIMR, it is more favorable to ventricular remodeling and is associated with a lower incidence of hospitalization for heart failure than MVA.

Predicting functional mitral stenosis after restrictive annuloplasty for ischemic mitral regurgitation.

BACKGROUND:Although it has been realized that restrictive mitral valve annuloplasty (MVA) may re-sult in clinically significant functional mitral stenosis (MS), it still cannot be predicted. The purpose of this study was to identify risk factors for clinically significant functional MS following restrictive MVA surgery for chronic ischemic mitral regurgitation (CIMR).METHODS:One hundred and fourteen patients who underwent restrictive MVA with coronary artery bypass grafting (CABG) for treatment of CIMR were retrospectively reviewed. Clinically significant functional MS was defined as resting transmitral peak pressure gradient (PPG) ≥ 13 mmHg.RESULTS:During the follow-up period (range 6-12 months), 28 (24.56%) patients developed clinically significant functional MS. The PPG at follow-up was significantly higher than that measured in the early postoperative stage (3-5 days after surgery). Moreover, there was a linear correlation between the two measurements (r = 0.398, p < 0.001). Annuloplasty size ≤ 27 mm and early postoperative PPG ≥ 7.4 mmHg could predict clinically significant functional MS at 6-12 months postoperatively.CONCLUSIONS:Chronic ischemic mitral regurgitation patients treated with restrictive MVA and CABG have significant increases in PPG postoperatively. Annuloplasty size ≤ 27 mm and early postopera-tive PPG ≥ 7.4 mmHg can predict clinically significant functional MS at 6-12 months after surgery.

Long-term outcomes after coronary artery bypass graft with or without surgical ventricular reconstruction in patients with severe left ventricular dysfunction.

Background:Patients with chronic myocardial infarction (MI) and severe left ventricular (LV) dysfunction have poor clinical outcomes. This study aimed to determine whether coronary artery bypass graft (CABG) with surgical ventricular reconstruction (SVR) leads to further improvement in long-term patient outcomes compared with isolated CABG (I-CABG).Methods:From April 2010 to June 2013, 140 consecutive patients with chronic MI and severe LV dysfunction who received contrast-enhanced cardiovascular magnetic resonance imaging (CE-CMR) within 1 month before surgery were enrolled in this study. The cardiovascular events (CVEs) and long-term survival of patients who underwent CABG and SVR were compared with those who met the criteria for SVR but received I-CABG.Results:A total of 140 patients were included in the final analysis, including 70 patients who underwent CABG and SVR and 70 patients who underwent I-CABG. No differences were observed in the baseline characteristics, LV function, and late gadolinium enhancement (LGE) between the two groups. CABG+SVR patients experienced a longer cardiopulmonary bypass (CPB) time (116.0±35.0 vs. 100.2±23.8 minutes, P=0.002) and ventilation time [median (interquartile range): 22.0 (17.0, 37.0) vs. 20.0 (15.0, 24.0) hours, P=0.019] than I-CABG patients. During a mean follow-up of 123.1±12.7 months (range, 102-140 months), the CABG+SVR group had fewer rehospitalizations for congestive heart failure (CHF) (4.3% vs. 19.1%, P=0.007), but no statistical difference in the mortality rate was observed (2.9% vs. 4.4%, P=0.987). The cumulative CVE-free survival rate was significantly higher in CABG+SVR patients (87.0% vs. 67.6%, P=0.007).Conclusions:Our findings indicated that patients with chronic MI and severe LV dysfunction experienced similar perioperative outcomes after CABG+SVR or I-CABG. However, the CABG+SVR group resulted in fewer rehospitalizations for CHF and a higher cumulative CVE-free survival rate.

Effects of left atrial appendage surgical treatment on the incidence of ischemic cerebrovascular accidents in patients with atrial fibrillation undergoing cardiac surgery.

BACKGROUND:We sought to assess different surgical methods for left atrial appendage treatment to determine whether any could reduce the incidence of atrial fibrillation-related long-term ischemic cerebrovascular accidents.METHODS:A total of 1243 patients were treated with left atrial appendage removal, and 107 patients (8.6%) were lost to follow-up and excluded. The primary outcome was the long-term incidence of ischemic cerebrovascular events (ie, ischemic stroke, excluding transient ischemic attack) and all-cause mortality.RESULTS:Of the 1136 patients, 37 (3.3%) had ischemic cerebrovascular events. The 1-year, 5-year, and 10-year freedoms from long-term ischemic cerebrovascular events of the left atrial appendage extracardiac ligation group were 99.7%, 94.0%, and 90.8%, respectively. The 1-year, 5-year, and 10-year survivals of the left atrial appendage intracardiac suture group were 99.7%, 94.6%, and 93.6%, respectively. There was a significant difference between the left atrial appendage extracardiac ligation group and the left atrial appendage excision group (P = .041). Seventeen patients (4.6%) had long-term ischemic cerebrovascular events in the left atrial appendage extracardiac ligation group (1.1% per year), 14 patients (3.5%) in the left atrial appendage intracardiac suture group (0.9% per year), and 6 patients (1.7%) in the left atrial appendage excision group (0.44% per year). Left atrial appendage excision can reduce the occurrence of long-term thrombotic stroke compared with left atrial appendage extracardiac ligation (95% confidence interval, 1.09-9.26; P = .035).CONCLUSIONS:For patients with atrial fibrillation, the removal of the left atrial appendage can effectively prevent stroke caused by atrial fibrillation.

Risk Factors for Aortic Regurgitation Progression After Repair of Sinus of Valsalva Aneurysm.

BACKGROUND:The main treatment for a ruptured sinus of Valsalva aneurysm (SVA) is surgical repair. Postoperative progression of aortic regurgitation (AR) following SVA repair increases the risk of reoperation, which decreases the long-term survival. Thus, identifying the risk factors for postoperative AR progression is of great significance.METHODS:Adult patients who were diagnosed with ruptured SVA and underwent surgical repair at the current centre were reviewed. Necessary data in the institutional database were extracted. The perioperative and follow-up assessments of the aortic valve by transthoracic echocardiography were also obtained. The aortic regurgitation progression was grouped into three categories: newly developing, recurrence, and worsening. Sixteen (16) variables were screened to identify potential risk factors by univariate logistic regression analysis or Chi-squared test. Variables with p-values <0.1 were further analysed by multivariate logistic regression models to find independent risk factors.RESULTS:A total of 198 consecutive patients from June 2006 to January 2018 were included. The overall incidence of postoperative AR progression was 19.2% (38 of 198). After the univariate analysis, SVA originating from the right coronary sinus, coexisting with ventricular septal defect, larger diameter of aortic annulus, and larger cardiothoracic ratio were screened as potential risk factors. Multivariate analysis indicated that coexisting with a ventricular septal defect (VSD) (OR, 2.82; 95% CI, 1.217-6.532; p=0.016) and larger cardiothoracic ratio (OR, 1.061; 95% CI, 1.001-1.124; p=0.047) were independent risk factors for postoperative AR progression.CONCLUSIONS:To prevent postoperative AR progression after surgical repair, more careful inspection and appropriate surgical techniques are necessary for patients coexisting with VSD or with a larger cardiothoracic ratio.

The enlargement rate of ventricular septal rupture is a risk factor for 30-day mortality in patients with delayed surgery.

BACKGROUND:Postinfarction ventricular septal rupture (VSR) is an uncommon but challenging mechanical complication for surgeons. This study analyzed the impacts of rupture size on surgical outcomes in patients with VSR.METHODS:During a 15-year period, from January 2006 to December 2020, 112 patients underwent repairs of postinfarction VSR. Patient clinical data, including angiographic and echocardiographic findings, operative procedures, early morbidity and mortality, and survival time were collated. Univariable and multivariable analyses were performed to identify the risk factors of 30-day mortality.RESULTS:The 30-day mortality rate was 7.1% for the whole cohort. The mean survival time estimate was 147.2 months [95% confidence interval (CI): 135.6 to 158.9 months], with a 3-year survival rate of 91.2% and a 5-year survival rate of 89.0%. Multivariable analysis revealed that rupture enlargement rate is an independent risk factor of 30-day mortality. The receiver operating characteristic (ROC) curve indicated that the rupture enlargement rate could predicted the 30-day mortality with high accuracy.CONCLUSIONS:Delayed surgery may be considered for patients who respond well to aggressive treatment. The rupture enlargement rate is an independent risk factor for postoperative 30-day morality in patients with delayed VSR repair. Furthermore, the rupture enlargement rate has good predictive value for the prognosis of VSR patients.

Prognostic value of myocardial scar by magnetic resonance imaging in patients undergoing coronary artery bypass graft.

BACKGROUND:Previous studies demonstrated that scar tissue assessed by late gadolinium enhancement cardiovascular magnetic resonance imaging (LGE-CMR) is associated with recovery of cardiac function after coronary artery bypass graft (CABG) in patients with a history of myocardial infarction (MI). However, information on the association between myocardial scar at baseline and long-term survival after CABG in these patients is lacking.METHODS:From April 2010 to May 2013, consecutive patients with multivessel coronary artery disease (CAD, > 70% stenosis in ≥2 vessels) and MI (> 3 months) who underwent LGE-CMR within 1 month prior to isolated CABG were enrolled. Left ventricular functional parameters and scar tissue were assessed by LGE-CMR before surgery. A standard 17-segment model was used for scar quantification. Predictors for cardiovascular events (CVEs) were analyzed.RESULTS:Of 148 patients who met the study inclusion/exclusion criteria, 140 cases had follow-up data and were included in final analysis. Of the latter, 27 (19.3%) patients suffered CVEs perioperatively or during mean 89.6 ± 12.0 months follow-up. In Cox proportional hazard regression model, the most significant predictor for CVEs after CABG was the number of scar segments on LGE-CMR (Hazard ratio 2.078, 95% Confidence Interval 1.133-3.814, P= 0.018). In Receiver-Operator-Characteristic (ROC) analysis, number of scar segments ≥6 predicted CVEs (sensitivity, 74.1%; specificity, 95.6%; area under the curve [AUC] = 0.934, P < 0.001).CONCLUSIONS:Scar tissue identified by LGE-CMR appears to be an independent predictor of CVEs after CABG in patients with a history of MI, which might allow preoperative risk stratification.

Extracardiac Tricuspid Annuloplasty: A Novel Technique for Functional Tricuspid Regurgitation.

We report 3 cases of functional tricuspid regurgitation and demonstrate a novel tricuspid repair technique through the right atrioventricular groove without cardiopulmonary bypass or open heart surgery, which provides a new idea for the treatment of functional tricuspid regurgitation.

Surgical results and pathological analysis of cardiac fibroma in the adolescent and the adult.

BACKGROUNDS:Disparities may exist between the adolescent and the adult patients with cardiac fibromas in the symptoms, surgical outcomes, and pathological characteristics. The aim of this study was to compare short and midterm surgical outcomes of cardiac fibromas and to compare the biomarker expressions of tumor tissue samples between the adult and the adolescent.METHODS:Consecutive patients with the diagnosis of cardiac fibroma were admitted and received surgeries. Primary outcomes included in-hospital mortality, low cardiac output, and readmission due to heart failure. The expression of PCNA and Ki67, two widely adopted indicators of cell proliferation, were evaluated in tissue samples.RESULTS:A total of five adolescent patients and five adult patients diagnosed as cardiac fibroma were admitted and given surgeries. When compare with the adults, the adolescent patients were more likely to present symptoms on admission (P = .048). Postoperative low cardiac output syndrome was significantly higher in the adolescents than in the adults (80.0% vs 0.0, P = .048). The tumor volume relative to ventricular end diastolic diameter had good discriminative ability for low cardiac output (c statistics: 0.96). Pathologically, the percentage of PCNA-positive cell nuclei was significantly higher in the adolescents than in the adults (36.04% ± 10.54% vs 4.15% ± 3.93%, P = .001). However, there were no Ki67-positive nuclei in the 10 cases.CONCLUSIONS:In the current study, we found that postoperative low cardiac output was more likely to occur in the adolescent patients than in the adult patients. When compared with the adult patients, significantly more PCNA-positive nuclei were observed in the adolescents.

Subannular repair for moderate to severe ischemic mitral regurgitation: Still a long way to go. Authors' reply.

Long-term outcomes of mitral valve annuloplasty versus subvalvular sparing replacement for severe ischemic mitral regurgitation.

BACKGROUND:Although practice guidelines recommend surgery for patients with severe chronic ischemic mitral regurgitation (CIMR), they do not specify whether to repair or replace the mitral valve. The purpose of this study was to evaluate the long-term outcomes in patients with severe CIMR undergoing mitral valve annuloplasty (MVA) versus subvalvular sparing mitral valve replacement (MVR).METHODS:392 consecutive patients who underwent MVA or subvalvular sparing MVR for treatment of severe CIMR were retrospectively reviewed.RESULTS:After adjustment for baseline differences with multivariable regression analysis at 53 months follow-up (interquartile range, 34-81 months), there was no significant difference between the two groups for risk of major adverse cardiac or cerebrovascular events (MACCE), cardiac death, or all-cause death. Propensity score matching extracted 77 pairs. During the follow-up, compared with the MVR group, both the left atrium and left ventricle end-diastolic diameter were markedly larger (p = 0.013 and p = 0.033, respectively), and the incidence of mitral regurgitation recurrence was significantly higher in the MVA group (p < 0.001). No significant difference was observed between the two propensity score-matched groups in composite in-hospital outcomes, overall survival, freedom from cardiac death or MACCE, except subvalvular sparing MVR was associated with a lower incidence of hospitalization for heart failure than MVA (p = 0.015).CONCLUSIONS:Subvalvular sparing MVR is a suitable management of patients with severe CIMR, it is more favorable to ventricular remodeling and is associated with a lower incidence of hospitalization for heart failure than MVA.

Predicting functional mitral stenosis after restrictive annuloplasty for ischemic mitral regurgitation.

BACKGROUND:Although it has been realized that restrictive mitral valve annuloplasty (MVA) may re-sult in clinically significant functional mitral stenosis (MS), it still cannot be predicted. The purpose of this study was to identify risk factors for clinically significant functional MS following restrictive MVA surgery for chronic ischemic mitral regurgitation (CIMR).METHODS:One hundred and fourteen patients who underwent restrictive MVA with coronary artery bypass grafting (CABG) for treatment of CIMR were retrospectively reviewed. Clinically significant functional MS was defined as resting transmitral peak pressure gradient (PPG) ≥ 13 mmHg.RESULTS:During the follow-up period (range 6-12 months), 28 (24.56%) patients developed clinically significant functional MS. The PPG at follow-up was significantly higher than that measured in the early postoperative stage (3-5 days after surgery). Moreover, there was a linear correlation between the two measurements (r = 0.398, p < 0.001). Annuloplasty size ≤ 27 mm and early postoperative PPG ≥ 7.4 mmHg could predict clinically significant functional MS at 6-12 months postoperatively.CONCLUSIONS:Chronic ischemic mitral regurgitation patients treated with restrictive MVA and CABG have significant increases in PPG postoperatively. Annuloplasty size ≤ 27 mm and early postopera-tive PPG ≥ 7.4 mmHg can predict clinically significant functional MS at 6-12 months after surgery.