Early Improvement in Congestive Heart Failure Following Correction of Secondary Mitral Regurgitation in End-Stage Cardiomyopathy

Mitral regurgitation (MR) frequently complicates cardiomyopathy (CM) and contributes to symptoms of congestive heart failure (CHF). This study was undertaken to assess the changes in CHF and left ventricular (LV) systolic performance following mitral valve reconstruction (MVR) in patients with severe MR secondary to end-stage dilated CM. Nine consecutive patients (age 64 ± 10 yrs) with severe LV dysfunction (ejection fraction [EF] 18 ± 5% [10-25%]), severe MR and NYH Class III (n = 1) or IV (n = 8) CHF despite aggressive medical therapy underwent MVR. All patients were receiving therapy including digoxin, diuretics and afterload reducers. Two patients were awaiting heart transplantation. There were no operative deaths or deaths on 17 ± 5 (8-24) week follow-up (PostOp). All patients noted symptomatic improvement. NYH Class improved from 3.9 ± 0.3 pre-operatively (PreOp) to 1.7 ± 0.5 (p < 0.001). Diuretic requirements were markedly lower for 5 of 9 patients and stable for the remaining 4. Quantitative 2D echo/Doppler was performed on all patients PreOp and on 8 of 9 patients PostOp. MR was absent or mild on follow-up in all. Matched PreOp and PostOp LV end-diastolic volume (EDV), EF, forward cardiac output (CO) and regurgitant fraction (RF) were compared for change (Δ): Improvement in CHF occurred after MVR in all patients on short-term follow-up, accompanied by lower LV end-diastolic volume and increased EF and forward cardiac output. Mitral reconstruction may be new strategy for the treatment of patients with severe MR complicating end-stage cardiomyopathy.