HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Tadashi Isomura Hisayoshi Suma Akimitsu Yamaguchi Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Isomura, T. Articles by Yuda, A. Search for Related Content PubMed PubMed Citation Articles by Isomura, T. Articles by Yuda, A. Related Collections Coronary disease

Eur J Cardiothorac Surg 2003;23:614-619
© 2003 Elsevier Science NL

Left ventricular restoration for ischemic cardiomyopathy – comparison of presence and absence of mitral valve procedure

Hayama Heart Center, 1898 Shimoyamaguchi, Hayama, Kanagawa 240-0116, Japan

Received 6 October 2002; received in revised form 26 December 2002; accepted 29 December 2002.

^* Corresponding author. Tel.: +81-468-75-1717; fax: +81-468-75-3636
e-mail: isomura{at}hayamaheart.gr.jp

Objective: Association of mitral regurgitation (MR) with ischemic cardiomyopathy (ICM) increases the degree of heart failure and its surgical management remains controversial. The aim of this study was to report the surgical results in patients with or without MR in association with ICM. Patients and methods: Ninety-two patients with ischemic cardiomyopathy (left ventricular [LV] ejection fraction less than 30% with global akinesis) underwent LV restoration. Pre-operative New York Heart Association (NYHA) functional class was either in class-3 or -4 in all patients. MR was moderate to severe in 38 patients (MR-group) and none or mild in 54 patients (noMR-group). Moderate to severe MR was repaired in addition to the complete coronary artery bypass (CABG) and LV restoration. All patients were followed up and echocardiogram was repeated every 6 months after the surgery. Results: The procedure of LV restoration was selected pre- and intra-operative examination and endoventricular circular patch plasty was performed in 76, partial left ventricle resection in three, and sepal anterior exclusion in 13. CABG was performed in 85 patients with mean 2.4±1.1 grafts in MR-group and 3.2±0.4 grafts in noMR-group (P<0.0001). In MR-group mitral valve plasty was performed in 24 and replacement in 14. Undersized (26 or 28 mm) circumferential mitral ring was used in 16 patients for mitral plasty. Emergent operation required in 15 patients (13 in MR-group and two in noMR group) and the hospital mortality was 18.4% in MR-group and 3.7% in no MR-group. Mitral regurgitation recurred in two patients with posterior ring annuloplasty and they underwent valve replacement. The post-operative NYHA functional class improved to class-1 or -2 in 65 patients and cumulative survival in 5 years including emergent and hospital deaths was 60.9% in MR-group and 70.1% in noMR-group. Conclusion: In association of MR to ICM, emergent operation required more often and perioperative mortality rate was high. However, the aggressive combined mitral operation in addition to CABG and LV restoration showed the improvement of clinical symptom and quality of life after the surgery.

Key Words: Ischemic cardiomyopathy • Left ventricular restoration • Mitral regurgitation • Coronary artery bypass grafting • Endoventricular circular patch plasty

This article has been cited by other articles:

				S. A.F. Tulner, J. J. Bax, G. B. Bleeker, P. Steendijk, R. J.M. Klautz, E. R. Holman, M. J. Schalij, R. A.E. Dion, and E. E. van der Wall Beneficial Hemodynamic and Clinical Effects of Surgical Ventricular Restoration in Patients With Ischemic Dilated Cardiomyopathy Ann. Thorac. Surg., November 1, 2006; 82(5): 1721 - 1727. [Abstract] [Full Text] [PDF]

				S. Geidel, M. Lass, C. Schneider, G. Groth, S. Boczor, K.-H. Kuck, and J. Ostermeyer 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., June 1, 2005; 27(6): 1011 - 1016. [Abstract] [Full Text] [PDF]

				J. Braun, J. J. Bax, M. I.M. Versteegh, P. G. Voigt, E. R. Holman, R. J.M. Klautz, E. Boersma, and R. A.E. Dion Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in ischemic mitral regurgitation Eur. J. Cardiothorac. Surg., May 1, 2005; 27(5): 847 - 853. [Abstract] [Full Text] [PDF]