A new surgical approach for treating dilated cardiomyopathy with mitral regurgitation

Abstract

This technique offers a promising therapeutic alternative for the treatment of patients in refractory heart failure with cardiomyopathy and secondary mitral regurgitation.

Substituição valvar mitral com papilopexia cruzada e constrição anular em pacientes com insuficiência cardíaca

“…The absence of operative mortality and mechanical ventricular assistance mechanism presented in this study, compared with the other papers previously mentioned [14][15][16][17][18][19][20][21][22][23], may be explained by the fact that the crossing of the papillary muscles has allowed for left ventricular diastolic containment. Similarly, the annular constriction due to the implantation of an undersized prosthesis promotes the base ventricular remodeling, allowing improvement of cardiac performance.…”

“…The higher survival rates shown in this study compared with other mitral valve approaches forementioned [14][15][16][17][18][19][20][21][22][23] is probably due to the immediate improvement of ventricular performance in short-term (this factor may be considered to be a predictor of increased survival). It is possible that in a long-term follow-up, this improvement of ventricular performance can be a determining factor in increased survival rates.…”

“…A new possibility then arose: surgically approaching the mitral valve in patients with severe left ventricular dysfunction in order to improve ventricular performance. This possibility may be included in the surgical and therapeutic tools to combat advanced heart failure [14][15][16][17][18][19][20][21][22][23].…”

“…Some authors [14][15][16][17][18][19][20][21][22][23] have shown that the correction of mitral valve insufficiency in patients with severe left ventricular dysfunction -whether due to valvuloplasty or to valve replacement with preservation of subvalvar apparatus -was associated with low operative mortality and improves survival in the short-and mid-term.…”

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

“…Other surgical procedures have been suggested to benefit a large number of patients and these include cardiomyoplasty [4,5], partial left ventriculectomy (PLV) [6,7], mitral valve correction [8][9][10], biventricular pacing [11], and myocardial revascularization itself [12]. However, no consistently effective surgical alternative is available in this cohort of patients, who suffer a poor short-term outcome due to high mortality rates, from advanced dilated cardiomyopathy.…”