Intermediate-term outcome of mitral reconstruction in cardiomyopathy

Objective: Severe mitral regurgitation is a frequent complication of endstage cardiomyopathy that contributes to heart failure and predicts a poor survival, We studied the intermediate-term outcome of mitral reconstruction in 48 patients who had cardiomyopathy with severe mitral regurgitation and were operated ori between June 1993 and June 1997, Methods: Ages ranged from 33 to 79 years (63 +/- 6 years) with left ventricular ejection fractions of 8% to 25% (16% +/- 3%), All patients were receiving maximal drug therapy and were in New York Heart Association class III-TV with severe, refractory 4+ mitral regurgitation, Operatively, all 48 had undersized flexible annuloplasty rings inserted, 7 had coronary bypass grafts for incidental disease, 11 had prior bypass grafts, and 11 also had tricuspid valve repair, Results: One operative death occurred as a result of right ventricular failure, Postoperative transesophageal echocardiography revealed mild mitral regurgitation in 7 patients and no mitral regurgitation in 41. There were 10 late deaths, 2 to 47 months after mitral reconstruction, The 1- and 2-year actuarial survivals have been 82% and 71%, At a mean follow-up of 22 months, the number of hospitalizations for heart failure has decreased, and 1 patient has had heart transplantation. Significantly, New York Heart Association class improved from 3.9 +/- 0.3 before the operation to 2.0 +/- 0.6 after the operation. Twenty-four months after the operation, left ventricular volume and sphericity have decreased, whereas ejection fraction and cardiac output have increased. Conclusion: Whether this favorable modification of left ventricular function and geometry will persist remains unknown, However, mitral repair for cardiomyopathy with mitral regurgitation allows new strategies for these patients.