# Restrictive annuloplasty or replacement on reverse remodeling for nonischemic dilated cardiomyopathy

## TL;DR

This study compares mitral annuloplasty and replacement in patients with nonischemic dilated cardiomyopathy, finding that annuloplasty leads to better heart volume reduction.

## Contribution

The study provides evidence that mitral annuloplasty is more effective than replacement for reverse remodeling in nonischemic dilated cardiomyopathy.

## Key findings

- Mitral annuloplasty resulted in greater reduction in left ventricular end-systolic volume index compared to replacement.
- Annuloplasty was significantly associated with postoperative left ventricular reverse remodeling.
- There was no significant difference in survival rates between the two surgical strategies.

## Abstract

For patients with nonischemic dilated cardiomyopathy (NIDCM), the indications for and results of mitral surgery remain controversial. We reviewed a strategy of mitral repair and replacement for clinically relevant secondary mitral regurgitation (MR) in patients with NIDCM.

We retrospectively reviewed 65 patients with advanced NIDCM (LVEF < 40%) who underwent mitral surgery. Of them, 47 (72%) underwent mitral annuloplasty and 18 (28%) replacement for secondary MR. The primary endpoint was postoperative reduction in indexed LV end-systolic volume (LVESVI).

At baseline, there was no intergroup difference in LVESVI (123 ± 47 vs. 147 ± 37 ml/m2, P = 0.055), LVEF (27 ± 8% vs. 25 ± 6%, P = 0.41), incidence of severe MR (57% (27/47) vs. 72% (13/18), P = 0.40), or EuroSCORE II score (6.2% vs. 7.6%, P = 0.90). At 6 months, the annuloplasty group reduced LVESVI to a greater degree than the replacement group (P < 0.001), yielding significantly smaller postoperative LVESVI (96 ± 59 vs. 154 ± 61 ml/m2, P < 0.001) and better LVEF (P < 0.001). The rates of moderate/severe recurrent MR were 17% (8/47) and 0%, respectively. Multivariable analysis demonstrated that mitral annuloplasty (OR 6.10, 95% CI 1.14–32.8, P = 0.035) was significantly associated with postoperative LV reverse remodeling. Cumulative survival was not different between the groups (P = 0.26).

In patients with NIDCM, mitral annuloplasty reduced LV volume to a greater degree than did mitral replacement. These findings may assist with surgical options for secondary MR associated with NIDCM.

The online version contains supplementary material available at 10.1186/s13019-024-02719-6.