Posterior Pericardial Annuloplasty in Ischemic Mitral Regurgitation


  • Oguz Omay
  • Emre Ozker
  • Cenk Indelen
  • Murat Baskurt
  • Kaya Suzer
  • Ilhan Gunay



Background: Ischemic mitral regurgitation (IMR) is an important risk factor in coronary artery bypass grafting (CABG) operations. The decision to perform concomitant mitral annuloplasty along with the CABG depends on the surgeon's choice. The aim of this study was to evaluate the results of posterior annuloplasty procedures with autologous pericardium performed in patients with midadvanced and advanced functional ischemic mitral regurgitation.

Methods: Study participants were 36 patients with IMR (mean age 59 ± 10 years) who underwent posterior pericardial annuloplasty and CABG operations between 2002 and 2007. Preoperative and postoperative (mean follow-up 18 ± 1 months) MR grade, left atrium diameter, left ventricle end systolic diameter, left ventricle end diastolic diameter, left ventricle ejection fraction, and mitral valve gradients were measured with transthoracic echocardiography.

Results: There was one late mortality (2, 8%) but none of the patients required reoperation for residual MR. We did not observe thromboembolism, bleeding, or infective endocarditis. The mean MR grade decreased from 3.4 ± 0.5 to 0.5 ± 0.6 (P < .01), left atrium diameter decreased from 45.3 ± 5.5 mm to 43.2 ± 3.8 mm (P < .01), left ventricle end diastolic diameter decreased from 53.2 ± 5.6 mm to 50.9 ± 5.5 mm (P < .01), and left ventricle end systolic diameter decreased from 39.7 ± 5.8 mm to 34.6 ± 6.5 mm (P < .01), whereas mean left ventricle ejection fraction increased from 37.9% ± 6.1% to 43.7% ± 7.3% (P < .01). In the late postoperative term, the functional capacity of the patients increased from mean New York Heart Association class 2.6 ± 0.9 to 1.1 ± 0.5. We did not observe any gradient in the mitral valve preoperatively in any patient, but in the follow-up, the mean gradient increased to 1.3 ± 2.1 mmHg (P < .01).

Conclusion: Posterior pericardial annuloplasty with CABG in the treatment of IMR provides efficient mitral repair and significant decrease in the left atrium and left ventricle diameters, and provides a significant increase in left ventricular function. These results show IMR to be as effective as the other annuloplasty techniques. IMR is performed with autologuous material and therefore does not entail any risk of complications from prosthetic material and is highly cost-effective.


Bax JJ, Braun J, Somer ST, et al. 2004. Restrictive annuloplasty and coronary revascularization in ischemic mitral regurgitation results in reverse left ventricular remodeling. Circulation 110:II103-8.nBevilacqua S, Cerillo AG, Gianetti J, et al. 2003. Mitral valve repair for degenerative disease: is pericardial posterior annuloplasty a durable option? Eur J Cardiothorac Surg 23:552-9.nBorghetti V, Campana M, Scotti C, et al. 2000. Biological versus prosthetic ring in mitral-valve repair: enhancement of mitral annulus dynamics and left-ventricular function with pericardial annuloplasty at long term. Eur J Cardiothorac Surg 17:431-9.nBraun J, Bax JJ, Versteegh MI, et al. 2005. Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in ischemic mitral regurgitation. Eur J Cardiothorac Surg 27:847-53.nBraun J, Van de Veire NR, Klautz R, et al. 2008. Restrictive mitral annuloplasty cures ischemic mitral regurgitation and heart failure. Ann Thorac Surg 85:430-7.nChotivatanapong T, Kasemsarn C, Sungkahapong V, Chaisei P, Yosthasurodom C, Cholitkui S. 2001. Mitral valve repair with autologous pericardial ring. Asian Cardiovasc Thorac Ann 9:10-3.nCalafiore AM, D. Mauro MD, Gallina S, Canusa C, Iacò AL. 2003. Optimal length of pericardial strip for posterior mitral overreductive annuloplasty. Ann Thorac Surg 75:1982-4.nGeidel S, Lass M, Schneider C, et al. 2005. Downsizing of the mitral valve and coronary revascularization in severe ischemic mitral regurgitation results in reverse left ventricular and left atrial remodeling. Eur J Cardiothorac Surg 27:1011-6.nGeidel S, Schneider C, Lass M, et al. 2007. Changes of myocardial function after combined coronary revascularization and mitral valve downsizing in patients with ischemic mitral regurgitation and advanced cardiomyopathy. Thorac Cardiovasc Surg 55:1-6.nGillinov AM, Wierup PN, Blackstone EH, et al. 2001. Is repair preferable to replacement for ischemic mitral regurgitation? J Thorac Cardiovasc Surg 122:1125-41.nGrigioni F, Enriquez-Sarano M, Zehr KJ, Bailey KR, Tajik AJ. 2001. Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative doppler assessment. Circulation 103:1759-64.nKimYH, Czer LSC, Soukiasian HJ, et al. 2005. Ischemic mitral regurgitation: revascularization alone versus revascularization and mitral valve repair. Ann Thorac Surg 79:1895-901.nMatsukuma S, Eishi K, Yamachika S, et al. 2005. Risk factors of posterior pericardial annuloplasty for isolated posterior leaflet prolapse. Ann Thorac Surg 80:820-4.nPrifti E, Bonacchi M, Frati G, et al. 2001. Should mild-to-moderate and moderate ischemic mitral regurgitation be corrected in patients with impaired left ventricular function undergoing simultaneous coronary revascularization? J Card Surg 16:473-83.nReece TB, Tribble CG, Ellman PI, et al. 2004. Mitral repair is superior to replacement when associated with coronary artery disease. Ann Surg 239:671-7.nSalati M, Scrofani R, Santoli C. 1991. Posterior pericardial annuloplasty: a physicological correction? Eur J Cardiothorac Surg 5:226-9.nScrofani R, Moriggia S, Salati M, Fundaro P, Danna P, Santoli C. 1996. Mitral valve remodeling: long-term results with posterior pericardial annuloplasty. Ann Thorac Surg 61:895-9.n



How to Cite

Omay, O., Ozker, E., Indelen, C., Baskurt, M., Suzer, K., & Gunay, I. (2009). Posterior Pericardial Annuloplasty in Ischemic Mitral Regurgitation. The Heart Surgery Forum, 12(5), E285-E290.