Background: The 6-min walking test (6MWT) is a simple test, which does not require expensive equipment or advanced training. It has been used in heart failure patients to assess exercise tolerance, the effects of therapy and prognosis. Accordingly, post-surgical cardiac rehabilitation may be a potential field of application of this test. Materials and method: One thousand three hundred seventy patients (70% males, mean age 64 AE 10 years), consecutively admitted for intensive cardiac rehabilitation, underwent 6MWT within 15 days after different types of cardiac surgery (67% coronary artery bypass graft (CABG), 25% valve replacement, 4% both, 4% other). The 6MWT was repeated in a subgroup of 348 patients after 15 AE 3 days of an in-hospital cardiac rehabilitation programme. Results: 6MWT (expressed as absolute value in metres and as a percentage of the predicted value) was well tolerated in all patients. The mean distance walked in 1370 patients was 304 AE 89 m (corresponding to 58 AE 15% of the predicted value). Distances walked were significantly shorter in older patients than younger ( p < 0.05) and in women compared to men (251 AE 78 m, 53 AE 15%, vs 328 AE 34 m, 60 AE 14%, p < 0.001). Furthermore, the absolute distance walked in 6 min was significantly shorter in diabetics compared to non-diabetics (283 AE 85 m vs 302 AE 87 m, p = 0.001) and in no CABG compared to CABG patients (285 AE 91 m vs 303 AE 84 m, p < 0.001); no relation was found between distance walked and left ventricular ejection fraction ( p = 0.5). Gender, age, comorbidities and type of surgery were independently associated with 6MWT in the multivariate model. In the subgroup of patients repeating the 6MWT after the rehabilitation programme, the distance walked significantly increased (from 281 AE 90 m, 51 AE 76%, to 411 AE 107 m, 77 AE 81%, p < 0.001). The extent of improvement observed was similar according to sex, age, presence/absence of diabetes and type of surgery. Conclusions: Our data suggest that 6MWT is feasible and well tolerated in adult and older patients shortly after uncomplicated cardiac surgery and provides reference values for distance walked after cardiac surgery in this population. #

AimsWe present 5-year echocardiographic results of combined undersizing mitral ring annuloplasty (UMRA) and coronary artery bypass grafting (CABG) in chronic ischaemic mitral regurgitation (CIMR). Methods and resultsTwo hundred and fifty-one patients (aged 68.4 + 8.1, 62.5% male) undergoing combined CABG and UMRA in our Institution (Cardiac Surgery, Careggi Hospital, Florence, Italy) between September 2001 and March 2007 were prospectively enrolled in the study. Median follow up was 32.9 months [interquartile range (IQR) 17.5-51.6]. Fourteen patients with significant residual mitral regurgitation (MR) needing immediate intraoperative revision (n ¼ 3) or at discharge (n ¼ 11) were excluded from the study. Serial echocardiograms were performed in 220 survivors at baseline, discharge, and annually thereafter. Additionally, 17 patients died (2 early and 15 late deaths) and were also excluded from the study. MR remained stable at 1 year and re-increased at 3 years (P , 0.001) and 5 years (P , 0.001). Fiveyear actuarial survival was 83.2 + 4.4. Five-year freedom from re-operation for failed repair was 78.2 + 4.9%. Mean systolic and diastolic diameters decreased significantly at discharge (P ¼ 0.001 and P ¼ 0.01, respectively) and at early follow up (P ¼ 0.004 and P ¼ 0.02) but raised at 3 years (P , 0.001) and 5 years (P , 0.001). Systolic and diastolic sphericity indexes improved at discharge (P , 0.001) remained stable at 1 year but they re-increased at 3-year control (P ¼ 0.006 and P ¼ 0.03, respectively) with a late raise exceeding the pre-operative value (P , 0.001). Left ventricular reverse remodelling was observed in 44.2% of the study population with 10.3% of patients showing further left ventricular dilatation. At multivariable model, end-systolic volume 145 mL, systolic sphericity index 0.7, myocardial performance index 0.9, and wall motion score index 1.5 were predictors of recurrent MR. ConclusionOur findings emphasize the need for improved repair technique and better patient selection to identify patients with anticipated repair failure who could benefit more from valve replacement or other procedure directly addressing ventricular tethering.--

Mitral valve replacement is a suitable option for patients with chronic ischemic mitral regurgitation and impaired left ventricular function. It provides better results in terms of freedom from reoperation with comparable valve-related complication rates.

Preoperative symmetric tethering with anterior mitral leaflet predominance was strongly associated with recurrence of mitral regurgitation. Measures of leaflet tethering resulted in fundamental findings to identify ischemic patients who can really benefit from restrictive annuloplasty. Further larger studies are necessary to confirm our results.

No abstract