Five-year real world outcomes of GeoForm ring implantation in patients with ischemic mitral regurgitation

• DOI: 10.1016/j.jtcvs.2014.02.051
• Publication Date: 2014-02-21T22:46:22Z
• Authors: Tomasz A. Timek; Robert L. Hooker; Robin Collingwood; Alan T. Davis; Craig T. Alguire; Charles L. Willekes; Edward T. Murphy; John C. Heiser; Lawrence H. Patzelt
• Keywords: Pulmonary and Respiratory Medicine; Male; Michigan; Mitral Valve Annuloplasty; Myocardial Ischemia; Prosthesis Design; Disease-Free Survival; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Recurrence; Risk Factors; Humans; Hospital Mortality; Aged; Retrospective Studies; Heart Valve Prosthesis Implantation; Mitral Valve Insufficiency; Middle Aged; 3. Good health; Heart Valve Prosthesis; Quality of Life; Mitral Valve; Surgery; Female; Cardiology and Cardiovascular Medicine

Reductive ring annuloplasty represents the current standard surgical therapy for ischemic mitral regurgitation (IMR); however, the clinical results have been suboptimal. Etiology-specific prostheses such as the GeoForm annuloplasty ring have been designed to better address the annular and subvalvular perturbations associated with IMR. However, clinical experience is limited, and mid-term results are lacking.We reviewed the clinical outcomes of 86 patients who had undergone implantation of a GeoForm ring at our center from 2005 to 2011. Perioperative mortality and clinical parameters were derived from The Society of Thoracic Surgeons database. Follow-up survival was assessed using the Social Security Death Index. Surviving patients were interviewed by telephone for valve-specific follow-up data and to complete the Medical Outcomes Study, short-form, 36-item, quality-of-life questionnaire.The mean grade of IMR preoperatively was 3.1±0.8 (range, 1-4+), 0.2±0.4 in the immediate postoperative period, and 0.7±0.7 at the last mean follow-up point of 41 months; only 2 patients developed ≥2+IMR during the follow-up period, for a 5-year freedom from recurrent 2+ IMR of 86%. The mean left ventricular end-diastolic and end-systolic diameters decreased from before to after surgery from 6.0±0.0 cm to 5.3±09 cm and 5.0±0.9 cm to 4.3±1.1 cm, respectively (P<.001). Perioperative mortality was 5.8% (5 of 86), and 1-, 3-, and 5-year survival was 87%, 81%, and 75%, respectively. At the last follow-up point, 80% of patients were in New York Heart Association class I and II, and their quality of life was equal to, or better than, age-matched controls from the general population.Implantation of the GeoForm ring offers very good control of IMR, with low rate of recurrent IMR at mid-term follow-up. The use of this prosthesis was associated with good perioperative mortality, mid-term survival, and quality of life.