PMID- 15870044
OWN - NLM
STAT- MEDLINE
DCOM- 20061201
LR  - 20191109
IS  - 1522-6662 (Electronic)
IS  - 1098-3511 (Linking)
VI  - 8
IP  - 3
DP  - 2005
TI  - Surgical coronary revascularization with or without mitral valve repair of severe 
      ischemic dilated cardiomyopathy.
PG  - E146-50
AB  - BACKGROUND: Because patients with dilated cardiomyopathy tend to have a poor 
      prognosis with medical therapy, surgery with coronary bypass alone or associated 
      with mitral valve repair should be a promising feasible therapeutic option. We 
      evaluated the early effects of surgical coronary revascularization with or 
      without mitral valve repair in patients with severe dilated ischemic 
      cardiomyopathy. METHODS: The study group consisted of 38 patients aged 65 +/- 8 
      years with severe dilated ischemic cardiomyopathy, chest pain, and heart failure. 
      Twenty-four patients were in a New York Heart Association (NYHA) class > or =3, 
      and 14 patients were in class 2. Twenty patients had a degree of mitral 
      regurgitation defined as an effective regurgitant orifice > or =20 mm2. The mean 
      values (+/-SD) of the EuroSCORE, which evaluates operative risk, were 5 +/- 2.2. 
      Clinical and echocardiographic reevaluation followed at 6 months. RESULTS: All 
      patients underwent coronary artery bypass surgery with a mean of 2.3 +/- 0.8 
      grafts, and mitral valve repair with annuloplasty and Cosgrove ring insertion 
      were performed in 20 patients. No deaths occurred during the operative period. 
      Ten patients could not be reevaluated at 6 months, and 3 patients died (7.9% 
      mortality). At 6 months, the end-systolic volumes in 15 patients who underwent 
      coronary bypass plus mitral valve repair (group A) and in 13 patients who 
      underwent coronary bypass alone (group B) decreased, respectively, from 139 +/- 
      56 mL to 121 +/- 94 mL and from 122 +/- 48 mL to 96 +/- 36 mL (P < .05). The wall 
      motion score index also decreased from 1.9 +/- 0.3 to 1.4 +/- 0.4 and from 2.1 
      +/- 0.3 to 1.8 +/- 0.2, respectively. The mean values of the ejection fraction, 
      the peak early mitral inflow velocity, and the ratio of the peak early mitral 
      inflow velocity to the peak late mitral inflow velocity increased significantly 
      in both groups (P < .001, P < .01, and P < .05, respectively). The mean NYHA 
      functional class significantly improved in both groups (P < .0001). CONCLUSIONS: 
      In patients with severe ischemic dilated cardiomyopathy, surgical coronary 
      revascularization can be safely carried out during the operative and early 
      postoperative periods with low mortality rates. This procedure decreased left 
      ventricular end-systolic volume, consistently increased contractility, and 
      subsequently ameliorated the ejection fraction to produce improvements in 
      clinical condition according to the NYHA functional class. Similar results have 
      been obtained in patients who have undergone coronary bypass surgery and mitral 
      valve repair, despite a higher operative risk and longer cardiopulmonary bypass 
      circulation and aortic cross-clamping times.
FAU - Tsialtas, Dimitri
AU  - Tsialtas D
AD  - Universita degli Studi, Parma, Italy.
FAU - Bolognesi, Roberto
AU  - Bolognesi R
FAU - Reverberi, Claudio
AU  - Reverberi C
FAU - Beghi, Cesare
AU  - Beghi C
FAU - Manca, Carlo
AU  - Manca C
FAU - Gherli, Tiziano
AU  - Gherli T
LA  - eng
PT  - Controlled Clinical Trial
PT  - Journal Article
PL  - United States
TA  - Heart Surg Forum
JT  - The heart surgery forum
JID - 100891112
SB  - IM
MH  - Aged
MH  - Blood Flow Velocity
MH  - *Cardiac Surgical Procedures/mortality
MH  - Cardiomyopathy, Dilated/*complications/physiopathology/*surgery
MH  - Humans
MH  - Middle Aged
MH  - Mitral Valve/physiopathology/*surgery
MH  - Myocardial Contraction
MH  - Myocardial Ischemia/*complications/physiopathology/*surgery
MH  - *Myocardial Revascularization/mortality
MH  - Postoperative Period
MH  - Severity of Illness Index
MH  - Stroke Volume
EDAT- 2005/05/05 09:00
MHDA- 2006/12/09 09:00
CRDT- 2005/05/05 09:00
PHST- 2005/05/05 09:00 [pubmed]
PHST- 2006/12/09 09:00 [medline]
PHST- 2005/05/05 09:00 [entrez]
AID - NDN46LR4Y2GWTD50 [pii]
AID - 10.1532/hsf98.20041036 [doi]
PST - ppublish
SO  - Heart Surg Forum. 2005;8(3):E146-50. doi: 10.1532/hsf98.20041036.