Restrictive mitral valve anuloplasty in dilated cardiomyopathy

Moderate to severe mitral insufficiency (MI) importantly affects short-term survival in patients with dilated cardiomyopathy (DCM). Heart transplantation (HTX) represents first-choice therapy, but is the least available therapeutic option. Restrictive mitral valve anuloplasty (RMV) is possibly an alternative strategy. Material and methods: Since 1998, 11 (7/11 male, age 62±6 years) patients with DCM/IM underwent RMV at our Institution. Etiology was idiopathic in 5 patients and post-ischemic in 6. NYHA functional class was III in 2, IV in 9 cases; preoperative assisted ventilation was necessary in 2 patients. Two patients were awaiting for a donor heart, 3 had contraindications for HTX. Left ventricular enddiastolic volume (EDV) and ejection fraction (EF) were 232 6 35 ml and 0.24±0.04 respectively. Preoperative treatment included inotropic support with dopamine (6 mcg/Kg/min) and no reduction of ACE-inhibitors in all patients; mechanical support with intraaortic counterpulsation (IABP) was started before operation in 4 patients. RMV included implantation of a rigid ring (Baxter Carpentier-Edwards Classic); mean undersizing was 4.8 6 2.1. Three patients underwent associated left ventriculoplasty with an original approach. Coronary bypass was performed in 3 cases. Cold blood cardioplegia with normothermic induction was used in all patients. Results: There was 1 hospital death. Mean duration of assisted ventilation was 3.1±3.4 days. Catecholamine support was 8±6.6 days. Nine patients were supported with IABP (1.2±0.9 days). Delayed sternal closure was used in 1 case. Pre discharge EDV and EF were respectively 189 6 32 ml and 0.32±0.07 (p<0.001). At a 9.3-month mean follow-up, 9 patients are in I–II NYHA class and 1 is awaiting for HTX. Conclusions: RMV may represent a relatively low-risk surgical alternative or bridge to HTX in some patients. Optimal patients’ selection and medium-to-long term result are unknown.