Background. Restrictive mitral annuloplasty (RMA) can be an effective treatment for functional mitral regurgitation in congestive heart failure (CHF). Passive cardiac restraint is another surgical approach, but the midterm results are not well characterized.Methods. Thirty patients with functional mitral regurgitation were prospectively randomized to RMA alone or cardiac restraint with the CorCap Cardiac Support Device (Acorn Cardiovascular Inc, St. Paul, MN) and RMA. Clinical, echocardiographic, New York Heart Association (NYHA) functional class, Short Form 36-Item Health Survey (SF-36) quality of life scores, and N-terminal pro-B-type natriuretic peptide (NT- proBNP) results were analyzed.Results. No hospital deaths or device-related complications occurred. The two groups had comparable morbidity (p = 0.34). Echocardiography showed a trend towards a slightly better functional improvement during follow-up in CorCap plus RMA patients (between groups, p = 0.001). Both groups showed improved results for SF-36, NYHA, and NT- pro. BNP; however, CorCap plus RMA patients had significantly better SF-36 at discharge ( p = 0.003), postoperative NYHA ( p = 0.05), and NT- pro. BNP (p = 0.001). Survival ( p = 0.46), freedom from CHF (p = 0.23), and rehospitalization ( p = 0.28) were comparable. Patients in whom CHF developed after postoperative day 1 had higher NT- pro. BNP values (p = 0.001 at all time-points).Conclusions. Adjunctive application of CorCap with RMA correlated with better NT- pro. BNP at short-term follow-up together with slightly improved echocardiographic and functional results. This deserves further evaluation at midterm and long-term follow-up. Reduction of NT- pro. BNP at follow-up may be suggested as a prognostic index.

Neurohormonal and echocardiographic results after CorCap and mitral annuloplasty for dilated cardiomyopathy

Onorati, Francesco;
2009-01-01

Abstract

Background. Restrictive mitral annuloplasty (RMA) can be an effective treatment for functional mitral regurgitation in congestive heart failure (CHF). Passive cardiac restraint is another surgical approach, but the midterm results are not well characterized.Methods. Thirty patients with functional mitral regurgitation were prospectively randomized to RMA alone or cardiac restraint with the CorCap Cardiac Support Device (Acorn Cardiovascular Inc, St. Paul, MN) and RMA. Clinical, echocardiographic, New York Heart Association (NYHA) functional class, Short Form 36-Item Health Survey (SF-36) quality of life scores, and N-terminal pro-B-type natriuretic peptide (NT- proBNP) results were analyzed.Results. No hospital deaths or device-related complications occurred. The two groups had comparable morbidity (p = 0.34). Echocardiography showed a trend towards a slightly better functional improvement during follow-up in CorCap plus RMA patients (between groups, p = 0.001). Both groups showed improved results for SF-36, NYHA, and NT- pro. BNP; however, CorCap plus RMA patients had significantly better SF-36 at discharge ( p = 0.003), postoperative NYHA ( p = 0.05), and NT- pro. BNP (p = 0.001). Survival ( p = 0.46), freedom from CHF (p = 0.23), and rehospitalization ( p = 0.28) were comparable. Patients in whom CHF developed after postoperative day 1 had higher NT- pro. BNP values (p = 0.001 at all time-points).Conclusions. Adjunctive application of CorCap with RMA correlated with better NT- pro. BNP at short-term follow-up together with slightly improved echocardiographic and functional results. This deserves further evaluation at midterm and long-term follow-up. Reduction of NT- pro. BNP at follow-up may be suggested as a prognostic index.
2009
Aged
Cardiomyopathy, Dilated
Combined Modality Therapy
Echocardiography, Doppler, Color
Echocardiography, Transesophageal
Female
Follow-Up Studies
Heart Failure
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Mitral Valve
Mitral Valve Insufficiency
Natriuretic Peptide, Brain
Peptide Fragments
Postoperative Complications
Ventricular Dysfunction, Left
Echocardiography
Heart Valve Prosthesis
Heart-Assist Devices
Polyesters
Surgical Mesh
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/1025558
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