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Eur J Cardiothorac Surg 2006;29:S266-S271
© 2006 Elsevier Science NL

End-stage cardiomyopathy and secondary mitral insufficiency surgical alternative with prosthesis implant and left ventricular restoration

Cardiovascular Surgery Department, Federal University of São Paulo, Paulista School of Medicine, Brazil

Received 2 February 2006; received in revised form 23 February 2006; accepted 1 March 2006.

^_* Corresponding author. Address: Rua Borges Lagoa, 1080 – 7°A, Cep. 04038-031, São Paulo, SP, Brazil. Tel.: +55 11 5574 6611; fax: +55 11 5574 6786. (Email: enio.buffolo{at}terra.com.br).

Background: Secondary mitral insufficiency is a strong risk factor for death in end-stage cardiomyopathy. The possible correction of mitral regurgitation has now been accepted as an alternative to cardiac transplantation in a special subset of patients. We propose a new surgical approach that consists of implantation of a mitral prosthesis that is smaller than the annulus, and preservation and traction of the papillary muscles to reduce sphericity of the left ventricle. Methods: Between December 1995 and September 2005, 116 patients with dilated cardiomyopathy underwent this procedure, with the following etiologic factors: ischemic (68), idiopathic (43), Chagas disease (3), viral (1), and postpartum (1). The patients were analyzed according to clinical criteria, echocardiographic findings, and morphology of left ventricle. Results: All patients were in an end-stage phase, requiring >2 hospital admissions over the past 3 months, despite receiving full medication. Furthermore, seven were in intensive care unit receiving intravenous drugs or intra-aortic balloon counterpulsation, and one was in cardiogenic shock. Hospital mortality was 16.3% (19/116), yet midterm follow-up showed a relatively flat late survival curve, with evidence of improved clinical status, better echocardiographic parameters, and reduction in ventricular sphericity. Conclusions: The high early mortality rate related to other clinical conditions at the time of surgery. However, the resultant flat survival after this early interval offers a promising long-term therapeutic alternative for the treatment of patients in refractory heart failure with cardiomyopathy that is associated with moderate or severe secondary mitral regurgitation.

Key Words: Heart failure • End-stage cardiomyopathy • Mitral insufficiency • Left ventricular restoration