Epicardial Cardiac Basal Annuloplasty: Preliminary Findings on Extra-cardiac Mitral Valve Repair

Raman, Jai; Hare, David; Storer, Meg; Hata, Mitsumasa

doi:10.1016/j.hlc.2009.05.704

« Previous Next »Heart, Lung and Circulation
Volume 18, Issue 6 , Pages 401-406, December 2009

Epicardial Cardiac Basal Annuloplasty: Preliminary Findings on Extra-cardiac Mitral Valve Repair

Jai Raman, MMedBS, FRACS, PhD
- Section of Cardiothoracic Surgery, University of Chicago, MC 5040, 5841 South Maryland Avenue, Chicago, IL 60637, USA
- Department of Cardiac Surgery, Austin Hospital, University of Melbourne, Studley Road, Heidelberg, VIC 3084, Australia
- Corresponding author at: Section of Cardiothoracic Surgery, University of Chicago, MC 5040, 5841 South Maryland Avenue, Chicago, IL 60637, USA. Tel.: +1 773 834 2807; fax: +1 773 834 9114.
David Hare, MD
- Section of Cardiothoracic Surgery, University of Chicago, MC 5040, 5841 South Maryland Avenue, Chicago, IL 60637, USA
- Department of Cardiac Surgery, Austin Hospital, University of Melbourne, Studley Road, Heidelberg, VIC 3084, Australia
- Tel.: +1 773 834 2807/61 3 9496 5000; fax: +1 773 702 4187.
Meg Storer, RN, BSN, MSN
- Section of Cardiothoracic Surgery, University of Chicago, MC 5040, 5841 South Maryland Avenue, Chicago, IL 60637, USA
- Department of Cardiac Surgery, Austin Hospital, University of Melbourne, Studley Road, Heidelberg, VIC 3084, Australia
- Tel.: +1 773 834 2807/61 3 9496 5000; fax: +1 773 702 4187.
Mitsumasa Hata, MD, PhD
- Section of Cardiothoracic Surgery, University of Chicago, MC 5040, 5841 South Maryland Avenue, Chicago, IL 60637, USA
- Department of Cardiac Surgery, Austin Hospital, University of Melbourne, Studley Road, Heidelberg, VIC 3084, Australia
- Tel.: +1 773 834 2807/61 3 9496 5000; fax: +1 773 702 4187.

Received 19 June 2008; received in revised form 18 April 2009; accepted 14 May 2009.

Background

Correction of functional mitral regurgitation in ischaemic heart disease, with a better risk:benefit ratio is an unmet need. A new methodology of external approach of correcting the annulus (BACE: basal annuloplasty of the cardia externally) to repair and stabilise the mitral valve without entering the heart was used in this prospective study. This study was conducted to assess the efficacy and safety of the concept BACE device in patients with moderate functional mitral valve regurgitation as a result of symptomatic coronary artery disease and heart failure.

Methods

The study involved a group of patients who had complex cardiac surgery between January 2000 and December 2001 at the University of Melbourne Campus Hospitals, Melbourne, Australia. Twelve patients with ischaemic heart disease, congestive heart failure, and moderate functional mitral regurgitation (MR) (minimum 2+) underwent the BACE procedure along with coronary artery bypass grafting and/or left ventricular reconstruction.

Results

No peri-operative complications or deaths related to surgical procedures occurred in the study group. There were no clinically significant problems related to the BACE implantation procedure. Mean MR grade was significantly improved in BACE Group from baseline to post BACE implant (2.8 pre- and 0.3 post-surgery; P<0.05). Mean left ventricular ejection fraction (LVEF) was significantly improved (P<0.05) and maintained at 6, 12, and 18 months post BACE implant compared to pre-operative baseline, with a mean improvement of 20% (24% at baseline to 44% at 18 months post-operatively) (P<0.05). In addition to that the patients also had a significant improvement (P<0.05) in mean New York Heart Association (NYHA) functional status from pre-operative baseline to 6 and 18 months post procedure with BACE.

Conclusions

External stabilisation of the cardiac base with BACE was associated with significant improvement in mitral valve function with no significant intra-operative or post-operative problems in patients with moderate functional MR. These findings support further study of BACE in functional MR.

Keywords: Mitral regurgitation, Repair, Extra-cardiac, Heart failure