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Arafat AA, Alghamdi R, Alfonso JJ, Shalaby MA, Alotaibi K, Pragliola C. Concomitant Mitral Valve Repair vs Replacement During Surgical Ventricular Restoration for Ischemic Cardiomyopathy. Angiology 2024; 75:331-339. [PMID: 36710003 DOI: 10.1177/00033197231154353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
There is no consensus regarding mitral valve management during surgical ventricular restoration (SVR) for ischemic cardiomyopathy. We compared the impact of SVR with mitral valve repair (MVr) vs replacement (MVR) on postoperative outcomes and long-term survival in ischemic cardiomyopathy and mitral regurgitation patients. This study included 112 patients who underwent SVR from 2009 to 2018 with MVr (n = 75) or MVR (n = 37). Patients who had MVR had higher Euro SCORE II, dyspnea class, a lower ejection fraction, higher pulmonary artery systolic pressure, higher grade of preoperative mitral and tricuspid regurgitation, and higher end-diastolic and end-systolic diameters. Intra-aortic balloon pump was more commonly used in patients with MVR. Hospital mortality occurred in 7 (9.33%) patients in the MVr group vs 3 (8.11%) in the MVR group (P > .99). Freedom from rehospitalization at 1, 5, and 7 years was 87%, 76%, and 70% in the MVr group and 83%, 61%, and 52% in the MVR group (P = .191). Survival at 1, 5, and 7 years was 88%, 78%, and 74% in the MVr group and 88%, 56%, and 56% in the MVR group (P = .027). Adjusted survival did not differ between groups.MVr or MVR are valid options in patients undergoing SVR, with good long-term outcomes.
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Affiliation(s)
- Amr A Arafat
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Rawan Alghamdi
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Juan J Alfonso
- Cardiac Research Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Mostafa A Shalaby
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Khaled Alotaibi
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Claudio Pragliola
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
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Results of Left Ventricular Reconstruction With and Without Mitral Valve Surgery. Ann Thorac Surg 2019; 109:753-761. [PMID: 31472132 DOI: 10.1016/j.athoracsur.2019.07.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/22/2019] [Accepted: 07/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study aims to compare the midterm outcomes of left ventricular reconstruction with those of left ventricular reconstruction plus mitral valve surgery in patients with left ventricular aneurysm due to anterior myocardial infarction and moderate mitral regurgitation. METHODS A total of 523 patients (75 who underwent left ventricular reconstruction plus mitral valve surgery and 448 who underwent left ventricular reconstruction) with concomitant moderate mitral regurgitation were included in the study population. All-cause mortality was considered the primary endpoint. Major adverse cardiovascular and cerebrovascular events, including death, myocardial infarction, stroke, and subsequent mitral valve surgery, were considered secondary endpoints. Multivariable proportional hazards Cox regression models were used to assess the associations between groups and outcomes. In the sensitivity analysis we excluded patients who did not undergo coronary artery bypass graft and repeated the statistical analysis above. RESULTS The median follow-up time among all patients was 41 months. There was no significant difference between the left ventricular reconstruction plus mitral valve surgery and the left ventricular reconstruction groups with regard to all-cause mortality (P = .208) and major adverse cardiovascular and cerebrovascular events (P = .817) after adjustment for covariates. In the sensitivity analysis there was no significant difference between the left ventricular reconstruction plus mitral valve surgery and left ventricular reconstruction groups with regard to all-cause mortality (P = .158) and major adverse cardiovascular and cerebrovascular events (P = .651) after adjustment for covariates. CONCLUSIONS The clinical outcomes of left ventricular reconstruction are comparable with those of left ventricular reconstruction plus mitral valve surgery in patients with left aneurysm and moderate mitral regurgitation.
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Mihos CG, Yucel E, Santana O. The role of papillary muscle approximation in mitral valve repair for the treatment of secondary mitral regurgitation. Eur J Cardiothorac Surg 2017; 51:1023-1030. [PMID: 28040676 DOI: 10.1093/ejcts/ezw384] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/26/2016] [Indexed: 01/28/2023] Open
Abstract
Secondary mitral regurgitation (MR) is present in up to half of patients with dilated cardiomyopathy, and is associated with a poor prognosis. It primarily results from progressive left ventricular remodelling, papillary muscle displacement and tethering of the mitral valve leaflets. Mitral valve repair with an undersized ring annuloplasty is the reparative procedure of choice in the treatment of secondary MR. However, this technique is associated with a 30-60% incidence of recurrent moderate or greater MR at mid-term follow-up, which results in progressive deterioration of left ventricular function and increased morbidity. Combined mitral valve repair and papillary muscle approximation has been applied in order to address both the annular and subvalvular dysfunction that coexist in secondary MR, which include graft and suture-based techniques. Herein, we provide a systematic review of the published literature regarding the technical aspects, clinical application, and outcomes of mitral valve repair with combined ring annuloplasty and papillary muscle approximation for the treatment of secondary MR.
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Affiliation(s)
- Christos G Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Orlando Santana
- The Division of Cardiology at Columbia University, Mount Sinai Heart Institute, Miami Beach, FL, USA
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Jouan J. Mitral valve repair over five decades. Ann Cardiothorac Surg 2015; 4:322-34. [PMID: 26309841 DOI: 10.3978/j.issn.2225-319x.2015.01.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/27/2014] [Indexed: 01/13/2023]
Abstract
It has become evident that mitral valve (MV) repair is the preferable treatment for the majority of patients presenting with severe mitral regurgitation (MR). This success clearly testifies that the surgical procedure is accessible, reproducible and is carrying excellent long-lasting results. From the pre-extracorporeal circulation's era to the last percutaneous approaches, a large variety of techniques have been proposed to address the different features of MV diseases. This article aimed at reviewing chronologically the development of these dedicated techniques through their origins and the debates that they generated in the literature.
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Affiliation(s)
- Jerome Jouan
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital, 75015 Paris, France
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Cagli K, Gedik HS, Korkmaz K, Budak B, Yener U, Lafci G. Transventricular mitral valve repair in patients with acute forms of ischemic mitral regurgitation. Tex Heart Inst J 2014; 41:312-5. [PMID: 24955051 DOI: 10.14503/thij-13-3201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Transventricular mitral valve surgery combined with left ventricular restoration avoids atriotomy and provides a larger operative field. We describe a series of 5 patients in whom we performed transventricular mitral valve repair by various techniques, such as band annuloplasty, papillary muscle reattachment, chordal cutting, and edge-to-edge repair. The more acute forms of ischemic mitral regurgitation, as found in our patients, can coexist with post-myocardial infarction contained rupture or post-myocardial infarction ventricular septal rupture. Because these patients already have an indication for ventriculotomy, concomitant transventricular repair of the mitral valve can render a separate atriotomy unnecessary and thereby shorten the duration of cardiopulmonary bypass. Moreover, in patients with acute presentations, the absence of atrial dilation (this last associated with chronic cases) might make transventricular repair a better choice than the more difficult atrial approach.
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Affiliation(s)
- Kerim Cagli
- Department of Cardiovascular Surgery (Drs. Cagli and Lafci), Turkiye Yuksek Ihtisas Hospital, 06100 Ankara; Department of Cardiovascular Surgery (Dr. Cagli), Hitit University, 19000 Corum; and Department of Cardiovascular Surgery (Drs. Budak, Gedik, Korkmaz, and Yener), Ankara Numune Research and Education Hospital, 06100 Ankara; Turkey
| | - Hikmet Selcuk Gedik
- Department of Cardiovascular Surgery (Drs. Cagli and Lafci), Turkiye Yuksek Ihtisas Hospital, 06100 Ankara; Department of Cardiovascular Surgery (Dr. Cagli), Hitit University, 19000 Corum; and Department of Cardiovascular Surgery (Drs. Budak, Gedik, Korkmaz, and Yener), Ankara Numune Research and Education Hospital, 06100 Ankara; Turkey
| | - Kemal Korkmaz
- Department of Cardiovascular Surgery (Drs. Cagli and Lafci), Turkiye Yuksek Ihtisas Hospital, 06100 Ankara; Department of Cardiovascular Surgery (Dr. Cagli), Hitit University, 19000 Corum; and Department of Cardiovascular Surgery (Drs. Budak, Gedik, Korkmaz, and Yener), Ankara Numune Research and Education Hospital, 06100 Ankara; Turkey
| | - Baran Budak
- Department of Cardiovascular Surgery (Drs. Cagli and Lafci), Turkiye Yuksek Ihtisas Hospital, 06100 Ankara; Department of Cardiovascular Surgery (Dr. Cagli), Hitit University, 19000 Corum; and Department of Cardiovascular Surgery (Drs. Budak, Gedik, Korkmaz, and Yener), Ankara Numune Research and Education Hospital, 06100 Ankara; Turkey
| | - Umit Yener
- Department of Cardiovascular Surgery (Drs. Cagli and Lafci), Turkiye Yuksek Ihtisas Hospital, 06100 Ankara; Department of Cardiovascular Surgery (Dr. Cagli), Hitit University, 19000 Corum; and Department of Cardiovascular Surgery (Drs. Budak, Gedik, Korkmaz, and Yener), Ankara Numune Research and Education Hospital, 06100 Ankara; Turkey
| | - Gokhan Lafci
- Department of Cardiovascular Surgery (Drs. Cagli and Lafci), Turkiye Yuksek Ihtisas Hospital, 06100 Ankara; Department of Cardiovascular Surgery (Dr. Cagli), Hitit University, 19000 Corum; and Department of Cardiovascular Surgery (Drs. Budak, Gedik, Korkmaz, and Yener), Ankara Numune Research and Education Hospital, 06100 Ankara; Turkey
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Maisano F, Alamanni F, Alfieri O, Bartorelli A, Bedogni F, Bovenzi FM, Bruschi G, Colombo A, Cremonesi A, Denti P, Ettori F, Klugmann S, La Canna G, Martinelli L, Menicanti L, Metra M, Oliva F, Padeletti L, Parolari A, Santini F, Senni M, Tamburino C, Ussia GP, Romeo F. Transcatheter treatment of chronic mitral regurgitation with the MitraClip system. J Cardiovasc Med (Hagerstown) 2014; 15:173-88. [DOI: 10.2459/jcm.0000000000000004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Minimally Invasive Edge-to-Edge Mitral Repair With or Without Artificial Chordae. Ann Thorac Surg 2013; 95:1347-53. [DOI: 10.1016/j.athoracsur.2012.12.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 12/07/2012] [Accepted: 12/10/2012] [Indexed: 11/23/2022]
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8
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Kaczorowski DJ, Blank M, Woo YJ. Intracardiac exposure for transventricular mitral valve ring annuloplasty repair during Dor ventriculoplasty. J Heart Lung Transplant 2012; 31:1236-8. [PMID: 22980953 DOI: 10.1016/j.healun.2012.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 06/02/2012] [Accepted: 08/04/2012] [Indexed: 11/19/2022] Open
Affiliation(s)
- David J Kaczorowski
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
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Mihos CG, Santana O, Lamelas J. Transventricular edge-to-edge repair of the mitral valve during surgical ventricular restoration: review of the literature. J Card Surg 2012; 27:52-5. [PMID: 22321113 DOI: 10.1111/j.1540-8191.2011.01388.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mitral valve surgery for functional ischemic mitral regurgitation (MR) in high-risk patients, including those requiring multiple concomitant cardiac operations, carries a significant risk of morbidity and mortality. In patients undergoing surgical ventricular restoration, transventricular edge-to-edge repair provides an effective alternative to conventional mitral valve surgery. We report such a case. METHODS A 67-year-old male with ischemic cardiomyopathy and severe left ventricular dysfunction presented to our institution with a 3-month history of dyspnea on exertion, angina, and leg edema. He was found to have triple-vessel coronary artery disease, a severely dilated left ventricle with an apical aneurysm, and moderate-to-severe MR (3+). In addition to coronary artery bypass graft surgery, an edge-to-edge mitral valve repair was undertaken via a longitudinal ventriculotomy performed for concomitant surgical ventricular restoration. RESULTS Total cardiopulmonary bypass and aortic cross-clamp times were 101 minutes and 86 minutes, respectively. Postoperative transesophageal echocardiography revealed no MR, and the patient was discharged home on postoperative day 9. A follow-up transthoracic echocardiogram revealed trace MR on postoperative day 15. At 11 months postoperative, the patient remains in New York Heart Association functional class I. CONCLUSION Transventricular edge-to-edge repair of the mitral valve in patients with ischemic cardiomyopathy and functional MR undergoing SVR is a safe and effective alternative to conventional valve surgery, and should be considered in this high-risk population.
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Affiliation(s)
- Christos G Mihos
- Division of Cardiology, Columbia University, Mount Sinai Heart Institute, Miami Beach, Florida 33140, USA
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Joseph Woo Y, McCormick RC. Transventricular mitral valve operations. Ann Thorac Surg 2011; 92:1501-3. [PMID: 21958802 DOI: 10.1016/j.athoracsur.2010.10.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 10/12/2010] [Accepted: 10/18/2010] [Indexed: 11/29/2022]
Abstract
We report transventricular mitral valve operations in 2 patients with severe mitral regurgitation and postinfarction left ventricular rupture and pseudoaneurysm. The first patient had direct papillary muscle involvement necessitating replacement of the mitral valve. The second patient had indirect mitral involvement allowing for placement of an atrial mitral annuloplasty ring via the left ventricle. Both patients showed no mitral valve regurgitation after replacement or repair and had uneventful postoperative recoveries. These cases demonstrate a feasible, alternative, transventricular approach to mitral valve replacement and repair.
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Affiliation(s)
- Y Joseph Woo
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
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11
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Castelvecchio S, Menicanti L, Donato MD. Surgical ventricular restoration to reverse left ventricular remodeling. Curr Cardiol Rev 2011; 6:15-23. [PMID: 21286274 PMCID: PMC2845790 DOI: 10.2174/157340310790231626] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 03/06/2009] [Accepted: 03/15/2009] [Indexed: 12/14/2022] Open
Abstract
Heart failure is one of the major health care issues in the Western world. An increasing number of patients are affected, leading to a high rate of hospitalization and high costs. Even with administration of the best available medical treatment, mortality remains high. The increase in left ventricular volume after a myocardial infarction is a component of the remodeling process. Surgical Ventricular Restoration (SVR) has been introduced as an optional therapeutic strategy to reduce left ventricular volume and restore heart geometry. So far, it has been established that SVR improves cardiac function, clinical status, and survival in patients with ischemic, dilated cardiomyopathy and heart failure. Since its first description , SVR has been refined in an effort to standardize the procedure and to optimize the results. This review will discuss the rationale behind surgical reversal of LV remodeling, the SVR technique, its impact on cardiac function and survival, and future expectations.
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12
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Castelvecchio S, Menicanti L, Donato MD. Cirugía de restauración ventricular para revertir el remodelado del ventrículo izquierdo. CIRUGIA CARDIOVASCULAR 2011. [DOI: 10.1016/s1134-0096(11)70052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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13
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Isomura T. Surgical left ventricular reconstruction. Gen Thorac Cardiovasc Surg 2011; 59:315-25. [DOI: 10.1007/s11748-010-0742-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 11/07/2010] [Indexed: 11/24/2022]
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Abstract
Congestive heart failure has become a major problem and the only surgical treatment for end-stage heart failure caused by dilated cardiomyopathy (DCM) had been heart transplantation. However, because of the shortage of donors, several procedures for non-transplant surgery have been developed. Published literature on left ventricular (LV) restoration was searched to review the new surgical procedures for treating patients with ischemic or non-ischemic DCM. LV restoration was initiated in the 1980s for repairing LV aneurysm. In the 1990s several surgical procedures were introduced for treating DCM, and the new evolving surgical treatment plays an important role in the management of DCM in the 21st century.
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Affiliation(s)
- Tadashi Isomura
- Cardiovascular Surgery, Hayama Heart Center, Hayama, Kanagawa 248-0116, Japan.
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Sajja LR, Mannam G, Dandu BRS, Pathuri S, Sompalli S, Anjaneyulu AV. Outcomes of Mitral Valve Repair for Chronic Ischemic Mitral Regurgitation. Asian Cardiovasc Thorac Ann 2009; 17:29-34. [DOI: 10.1177/0218492309102508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mitral regurgitation is a frequent complication of ischemic heart disease. A retrospective study was performed on 127 patients with significant ischemic mitral regurgitation (regurgitant jet area ≥6.0 cm2 and/or vena contracta width ≥0.70 cm) who underwent elective mitral valve repair between January 2001 and October 2007. Concomitant myocardial revascularization was carried out in all except one patient, and left ventricular restoration in 8. All patients had ring annuloplasty, with release of posterior mitral leaflet tethering in 21, leaflet resection in 7, chordal transfer in 3, and chordal shortening in 2. There were 4 (3.1%) hospital deaths. Two patients underwent successful mitral valve replacement for repair failure in the immediate postoperative period, and one had an unsuccessful valve replacement at 3 months. During a mean follow-up of 19.65 ± 13.21 months in 121 patients, 111 had trivial or no residual regurgitation, and 10 had mild regurgitation. Mitral valve repair for chronic ischemic mitral regurgitation is a reproducible technique with satisfactory early and mid-term outcomes and freedom from valve-related complications.
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Affiliation(s)
| | | | | | | | - Sriramulu Sompalli
- Department of Cardiac Anesthesiology, CARE Hospital, The Institute of Medical Sciences, Hyderabad, India
| | - AV Anjaneyulu
- Department of Cardiology, CARE Hospital, The Institute of Medical Sciences, Hyderabad, India
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16
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Sugiyama H, Hoshiai M, Naitoh A, Kadono T, Suzuki S, Sugita K. Outcome of Non-Transplant Surgical Strategy for End-Stage Dilated Cardiomyopathy in Young Children. Circ J 2009; 73:1045-8. [DOI: 10.1253/circj.cj-08-0928] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hisashi Sugiyama
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi
| | - Minako Hoshiai
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi
| | - Atsushi Naitoh
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi
| | - Toshie Kadono
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi
| | - Syoji Suzuki
- Second Division of Surgery, Faculty of Medicine, University of Yamanashi
| | - Kanji Sugita
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi
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Takeda K, Matsumiya G, Sakaguchi T, Matsue H, Masai T, Otake S, Taniguchi K, Sawa Y, Osaka Cardiovascular Surgery Research (OSCAR) group. Long-Term Results of Left Ventricular Reconstructive Surgery in Patients With Ischemic Dilated Cardiomyopathy A Multicenter Study. Circ J 2008; 72:1730-6. [DOI: 10.1253/circj.cj-08-0328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Koji Takeda
- Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
| | - Goro Matsumiya
- Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
| | - Taichi Sakaguchi
- Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
| | - Hajime Matsue
- Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital
| | - Shigeaki Otake
- Department of Cardiovascular Surgery, Osaka Police Hospital
| | - Kazuhiro Taniguchi
- Department of Cardiovascular Surgery, Japan Labor Health and Welfare Organization Osaka Rosai Hospital
| | - Yoshiki Sawa
- Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
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Di Donato M, Castelvecchio S, Brankovic J, Santambrogio C, Montericcio V, Menicanti L. Effectiveness of surgical ventricular restoration in patients with dilated ischemic cardiomyopathy and unrepaired mild mitral regurgitation. J Thorac Cardiovasc Surg 2007; 134:1548-53. [PMID: 18023681 DOI: 10.1016/j.jtcvs.2007.08.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 07/30/2007] [Accepted: 08/16/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Any grade of ischemic mitral regurgitation is associated with excess mortality. Whether mild ischemic mitral regurgitation should be repaired at the time of either coronary artery bypass grafting or surgical ventricular restoration is controversial. Surgical ventricular restoration is a treatment option for dilated post-infarction cardiomyopathy and has the potential to improve mitral functioning. The present study assessed the effectiveness of surgical ventricular restoration and unrepaired mild ischemic mitral regurgitation on left ventricular geometry, cardiac and functional status, and survival. METHODS We analyzed 55 patients with previous anterior infarction (age 65 +/- 10 years) and mild chronic functional mitral regurgitation who underwent surgical ventricular restoration and coronary artery bypass grafting without mitral repair at our center. Left ventricular volumes, ejection fraction, and geometric parameters were measured before and after surgery. RESULTS Even mild ischemic mitral regurgitation is characterized by abnormal left ventricular geometry when compared with that of patients without mitral regurgitation at comparable ventricular volumes and ejection fraction. Surgical ventricular restoration induces a significant decrease in left ventricular volumes, left ventricular diameters, and papillary muscle distance; and an improvement in ejection fraction and New York Heart Association class. Ischemic mitral regurgitation significantly decreases in the majority of patients. Survival is 93% at 1 year and 88% at 3 years. CONCLUSION Surgical ventricular restoration improves mitral functioning by improving geometry abnormalities. Survival is optimal and greater than would be expected in patients with post-infarction dilated ventricles and depressed left ventricular function. Our data indicate that mitral repair in conjunction with surgical ventricular restoration is unnecessary in such patients.
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Affiliation(s)
- Marisa Di Donato
- Department of Critical Care Medicine, University of Florence, Florence, Italy
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Lindblom D, Albåge A, Sartipy U. Surgery for ventricular tachycardia in patients undergoing surgical ventricular restoration. Multimed Man Cardiothorac Surg 2007; 2007:mmcts.2007.002816. [PMID: 24415212 DOI: 10.1510/mmcts.2007.002816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This article is a presentation of direct surgery for ventricular tachycardia in patients undergoing surgical ventricular restoration. The procedure includes a non-electrophysiologically guided subtotal endocardiectomy and cryoablation in addition to endoventricular patch plasty of the left ventricle. Coronary artery bypass surgery and mitral valve repair are performed concomitantly as needed. In our experience, this procedure yielded a 90% success rate in terms of freedom from spontaneous ventricular tachycardia, with an early mortality rate of 3.8%. Perioperative considerations and a short overview of the literature are presented.
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Affiliation(s)
- Dan Lindblom
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, 171 76 Stockholm, Sweden
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