Background: Mitral regurgitation dramatically decreases prognosis of patients with refractory heart failure. Cardiac Support Device (CorCap^®, Acorn Cardiovascular Inc.) is a new surgical treatment of refractory heart failure which has demonstrated reverse left ventricular (LV) remodeling.

Objective: To evaluate the effects of passive containment surgery on the mitral regurgitation.

Methods: From 2002 to 2006, twenty one patients (mean 54.2 ± 8.5 years, range 30 to 69 years, 6 women) were operated on for refractory heart failure with the Corcap^® device without associated procedure. Echocardiographic evaluation was performed before surgery, at 3 months, 6 months and 12 months. LV end-diastolic volume, LV end-systolic volume, LV ejection fraction, mitral valve regurgitation (quantified according to the proximal isovelocity surface area method by measuring the effective regurgitant orifice area (EROA)), mitral valvular tenting area, mitral coaptation distance, mitral annulus diameter and systolic sphericity index were measured. Percentage change in EROA and tenting area at 12 months were compared with the percentage change in LV end-diastolic and end-systolic volumes.

Results: Two (9,5%) patients died during the first months after surgery and were excluded of the analysis. For the 19 resting patients, at 12 months, compared to before surgery, LV end-diastolic volume was decreased from 211 ± 52ml to 165 ± 49ml (p < 0.01) (-22%), LV end-systolic volume was decreased from 160 ± 44ml to 117 ± 46ml (p < 0.01) (-26%), LV ejection fraction was increased from 23.6 ± 4% to 31.1 ± 8% (p < 0.01) and mitral regurgitation grade was reduced from mean 1.81 ± 0.87 to 1.16 ± 0.83 (p < 0.01) (-35%) and in 13 (68%) over 19 patients. EROA was reduced from 18.0 ± 9.5 mm² to 8.4 ± 5.8mm² (p < 0.01) (-50%). The percentage of change in EROA was well correlated to the percentage of decrease in LV end-diastolic volume (y = 0.35x + 0.03, r = 0.67, p < 0.05) and to the percentage of end-systolic volume (y = 0.39x + 0.06, r = 0.68, p < 0.05).

Concomitantly, the tenting area was decreased from 3.32 ± 0.82cm² to 2.50 ± 0.89cm² (p < 0.01) (-25%), the coaptation distance from 15.4 ± 3.3 mm to 11.2 ± 2.6 mm (p < 0.01) (-28%), the mitral annulus diameter from 41.1 ± 4.4 mm 37.6 ± 3.7 mm (p < 0.01) (-8.5%), and the sphericity index from 0.73 ± 0.11 to 0.66 ± 0.10 (p < 0.01) (-9.5%). Significant correlations were equally observed between reduction of tenting area and LV volumes.

These modifications were associated with an improvement of functional capacity (NYHA class, six-minute walking distance and quality of life score).

Conclusions: In this study, the Corcap^® procedure allowed improvement of cardiac dimensions associated with a significant reduction of mitral regurgitation in patients with severe refractory heart failure. The positive effect on mitral regurgitation was related to the cardiac reverse remodeling.