PMID- 12694786 OWN - NLM STAT- MEDLINE DCOM- 20030814 LR - 20190513 IS - 1010-7940 (Print) IS - 1010-7940 (Linking) VI - 23 IP - 4 DP - 2003 Apr TI - Left ventricular restoration for ischemic cardiomyopathy--comparison of presence and absence of mitral valve procedure. PG - 614-9 AB - OBJECTIVE: Association of mitral regurgitation (MR) with ischemic cardiomyopathy (ICM) increases the degree of heart failure and its surgical management remains controversial. The aim of this study was to report the surgical results in patients with or without MR in association with ICM. PATIENTS AND METHODS: Ninety-two patients with ischemic cardiomyopathy (left ventricular [LV] ejection fraction less than 30% with global akinesis) underwent LV restoration. Pre-operative New York Heart Association (NYHA) functional class was either in class-3 or -4 in all patients. MR was moderate to severe in 38 patients (MR-group) and none or mild in 54 patients (noMR-group). Moderate to severe MR was repaired in addition to the complete coronary artery bypass (CABG) and LV restoration. All patients were followed up and echocardiogram was repeated every 6 months after the surgery. RESULTS: The procedure of LV restoration was selected pre- and intra-operative examination and endoventricular circular patch plasty was performed in 76, partial left ventricle resection in three, and septal anterior exclusion in 13. CABG was performed in 85 patients with mean 2.4+/-1.1 grafts in MR-group and 3.2+/-0.4 grafts in noMR-group (P<0.0001). In MR-group mitral valve plasty was performed in 24 and replacement in 14. Undersized (26 or 28 mm) circumferential mitral ring was used in 16 patients for mitral plasty. Emergent operation required in 15 patients (13 in MR-group and two in noMR group) and the hospital mortality was 18.4% in MR-group and 3.7% in no MR-group. Mitral regurgitation recurred in two patients with posterior ring annuloplasty and they underwent valve replacement. The post-operative NYHA functional class improved to class-1 or -2 in 65 patients and cumulative survival in 5 years including emergent and hospital deaths was 60.9% in MR-group and 70.1% in noMR-group. CONCLUSION: In association of MR to ICM, emergent operation required more often and perioperative mortality rate was high. However, the aggressive combined mitral operation in addition to CABG and LV restoration showed the improvement of clinical symptom and quality of life after the surgery. FAU - Isomura, Tadashi AU - Isomura T AD - Hayama Heart Center, 1898 Shimoyamaguchi, Hayama, Kanagawa 240-0116, Japan. isomura@hayamaheart.gr.jp FAU - Suma, Hisayoshi AU - Suma H FAU - Yamaguchi, Akimitsu AU - Yamaguchi A FAU - Kobashi, Teisei AU - Kobashi T FAU - Yuda, Atsushi AU - Yuda A LA - eng PT - Comparative Study PT - Journal Article PL - Germany TA - Eur J Cardiothorac Surg JT - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JID - 8804069 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Cardiomyopathy, Dilated/complications/diagnostic imaging/*surgery MH - *Coronary Artery Bypass MH - Echocardiography MH - Female MH - Follow-Up Studies MH - Heart Valve Prosthesis Implantation MH - Heart Ventricles/surgery MH - Humans MH - Male MH - Middle Aged MH - Mitral Valve/*surgery MH - Mitral Valve Insufficiency/complications/diagnostic imaging/*surgery MH - Myocardial Ischemia/complications/diagnostic imaging/*surgery MH - Survival Rate MH - Ventricular Dysfunction, Left/complications/diagnostic imaging/*surgery EDAT- 2003/04/16 05:00 MHDA- 2003/08/15 05:00 CRDT- 2003/04/16 05:00 PHST- 2003/04/16 05:00 [pubmed] PHST- 2003/08/15 05:00 [medline] PHST- 2003/04/16 05:00 [entrez] AID - S1010794003000058 [pii] AID - 10.1016/s1010-7940(03)00005-8 [doi] PST - ppublish SO - Eur J Cardiothorac Surg. 2003 Apr;23(4):614-9. doi: 10.1016/s1010-7940(03)00005-8.