Mitral valve annuloplasty and myocardial revascularization in the treatment of ischemic dilated cardiomyopathy

Abstract

The aim of this study was to examine perioperative mortality and morbidity and midterm results in patients undergoing coronary bypass graft and mitral valve annuloplasty with advanced dilated cardiomyopathy. Sixty-one patients with ischemic dilated cardiomyopathy underwent coronary artery bypass grafting and mitral valve annuloplasty between January 1998 and December 2003. Patients eligible for revascularization that presented a mild or more severe mitral valve regurgitation at echocardiography (effective regurgitant orifice > 0.2 cm(2)) were considered for annuloplasty with a Cosgrove ring. New York Heart Association class (NYHA) III/IV was present in 40 patients (66%) and Canadian Cardiovascular Society class III-IV in 19 (31%). A previous acute myocardial infarction was reported in 48 patients (79%). The mean number of graft anastomoses was 2.5 +/- 0.7 and the left internal mammary artery was used in 49 patients (80%). In-hospital mortality was 4.9% (3 patients), due to unsuccessful weaning from cardiopulmonary bypass, multiple organ failure, and stroke, respectively. Left ventricle ejection fraction improved from 28.9% +/- 5.2% preoperatively to 35.4% +/- 8.1% at follow-up (P = 0.0001) and a significant reduction in NYHA III/IV was detected: from 40 patients preoperatively (66%) to 14 (31%) at follow-up (P = 0.031). Midterm cardiac-related mortality rate was 3.4%. In our experience combined coronary artery bypass grafting and ring annuloplasty for ischemic dilated cardiomyopathy can be performed with acceptable risks for in-hospital mortality and morbidity. Midterm results show a good survival rate and a durable functional improvement in this subset of patients.

Perioperative Strokes Following Surgical Correction of Mitral Valves: A Systematic Review and Meta-Analysis

“…CABG has been associated with a perioperative stroke rate of 1-5% and the predisposing factors are consistent with the risk factors for perioperative stroke following MV procedures [2] . A subgroup analysis of 4 studies [5][6][7][8] A few limitations are to be addressed in our study. The final list of studies analyzed gathered from different sources and locations can differ in their guidelines for MV procedures and postoperative neurological assessment and follow-up.…”

“…Four primary studies with a sample size of 389 patients were analyzed [5][6][7][8] . A perioperative stroke rate of 2.05% (8/389) and 30-day mortality rate of 6.68% (23/389) were obtained.…”

Cardiac stem cell therapy

“…Surgical treatment of dilated cardiomyopathy includes mitral valve surgery and coronary artery bypass grafting aiming to reduce intractable congestive heart failure [9]. For these cases, the inhospital mortality and mid-term cardiac-related mortality were 4.9% and 3.4%, respectively, and is accompanied by significantly improved left ventricular ejection fraction and reduction in NYHA class [10]. Therefore, we initiated a pilot study in which the surgical procedure and autologous stem cell transplantation were combined.…”

Η Μηχανική Υποβοήθηση Της Κυκλοφορίας Στην Χειρουργική Αντιμετώπιση Της Καρδιακής Ανεπάρκειας

“…Σα παξαπάλσ ζπλνιηθά απνηειέζκαηα ζρνιηάδνληαη ζπλνπηηθά ζε ζχγθξηζε κε ηε δηεζλή εκπεηξία. [180][181][182][183][184][185][186]188,[190][191][192]. Έρνπλ αλαθεξζεί θαιά απνηειέζκαηα κε εγρεηξήζεηο ρεηξνπξγηθήο αλαδηακφξθσζεο ηεο αξηζηεξάο θνηιίαο (απνθαηάζηαζε ηνπ κεγέζνπο θαη ηνπ ζρήκαηνο ηεο αξηζηεξάο θνηιίαο), ζπρλά ζπλδπαζκέλεο κε επηδηφξζσζε ηεο αλεπαξθνχζαο κηηξνεηδνχο (θαη επαλαηκάησζε) γηα ηελ αληηκεηψπηζε ηζραηκηθήο θαη κε ηζραηκηθήο δηαηαηηθήο κπνθαξδηνπάζεηαο ηειηθνχ ζηαδίνπ [193][194][195][196][197][198][199][200][201].…”