Surgical approaches to dilated cardiomyopathy

Abstract

Heart failure is one of the leading causes of hospitalization in the United States today. Congestive heart failure is a chronic progressive disease with the common central element being the remodeling of the cardiac chamber associated with ventricular dilation. Secondary mitral regurgitation is a complication of end-stage cardiomyopathy and is associated with a poor prognosis. Historically, these patients were not considered operative candidates due to the high morbidity and mortality in this patient population. Heart transplantation is now considered the standard of treatment for select patients with end-stage heart disease, however, it is only applicable to a small number of patients. In an effort to address this problem, newer and alternative surgical approaches are evolving, including mitral valve annuloplasty, the Batista myoplasty, and cardiomyoplasty. When these operative techniques that alter the shape of the left ventricle are utilized, in combination with optimal medical management for heart failure, survival is improved and patients can avoid or postpone transplantation.

Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation

“…Most surgeons advocate an undersized annuloplasty to achieve the greatest reduction in septallateral dimension. 4,22,23 In patients with ischemic and nonischemic cardiomyopathies, Bolling and coworkers 22,23 have achieved excellent early and midterm results with an undersized flexible annuloplasty ring. However, there are few available data to answer the following question: How small should the annuloplasty be?…”