Long-term outcomes of left ventricular posterior wall plication for ischemic mitral regurgitation

Kosuke Nakamae; Takashi Oshitomi; Hideyuki Uesugi; Ichiro Ideta; Kentaro Takaji; Toshiharu Sassa; Hidetaka Murata; Masataka Hirota

doi:10.1007/s12055-023-01527-2

Long-term outcomes of left ventricular posterior wall plication for ischemic mitral regurgitation

Indian J Thorac Cardiovasc Surg. 2023 Sep;39(5):462-470. doi: 10.1007/s12055-023-01527-2. Epub 2023 Jun 3.

Authors

Kosuke Nakamae¹, Takashi Oshitomi¹, Hideyuki Uesugi¹, Ichiro Ideta¹, Kentaro Takaji¹, Toshiharu Sassa¹, Hidetaka Murata¹, Masataka Hirota¹

Affiliation

¹ Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-Ku, Kumamoto City, Kumamoto, 861-4193 Japan.

PMID: 37609609
PMCID: PMC10442011 (available on 2024-09-01)
DOI: 10.1007/s12055-023-01527-2

Abstract

Purpose: To evaluate the early and long-term outcomes of left ventricular posterior wall plication for ischemic mitral regurgitation.

Methods: Patients with ischemic mitral regurgitation who underwent left ventricular posterior wall plication via right-sided left atriotomy at our institution between 2010 and 2020 were retrospectively reviewed. Cases with normal cardiac function, left ventricular end-systolic diameter < 50 mm, and left ventriculotomy approach were excluded.

Results: The mean follow-up period was 5.3 years [standard deviation (SD) = 3.5], with a maximum of 10 years. Among the 21 patients enrolled, 9 had New York Heart Association (NYHA) class ≥ III. Three patients required preoperative inotrope support, while two preoperative ventilator support. The mean left ventricular ejection fraction was 31.4% (SD: 8.6), and 16 patients had mitral regurgitation grade ≥ III. All patients underwent coronary artery bypass grafting and mitral annuloplasty. Concomitant surgeries included 11 chordae cutting and 3 tricuspid annuloplasties. One in-hospital death occurred due to sepsis. At the follow-up, echocardiographic data showed significant improvement in cardiac dilation and function and good control of mitral regurgitation. The serum brain natriuretic peptide level was significantly reduced, and 85% of patients improved to NYHA class I. Four deaths occurred later due to sudden, unknown causes. The 5- and 8-year survival rates were 60.2% and 46.8%, respectively, and the 5- and 8-year hospitalization rates due to heart failure were 14.9% and 21.3%, respectively.

Conclusion: The long-term outcomes of left ventricular posterior wall plication were satisfactory for controlling heart failure and improving survival rate and patient prognosis.

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-023-01527-2.

Keywords: Heart failure; Ischemic heart disease; Ischemic mitral regurgitation; Left ventricular posterior wall plication; Mitral valve repair.

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