PMID- 19607730
OWN - NLM
STAT- MEDLINE
DCOM- 20090901
LR  - 20240317
IS  - 1749-8090 (Electronic)
IS  - 1749-8090 (Linking)
VI  - 4
DP  - 2009 Jul 17
TI  - Surgery of secondary mitral insufficiency in patients with impaired left 
      ventricular function.
PG  - 36
LID - 10.1186/1749-8090-4-36 [doi]
AB  - BACKGROUND: Secondary mitral insufficiency (SMI) is an indicator of a poor 
      prognosis in patients with ischemic and dilated cardiomyopathies. Numerous 
      studies corroborated that mitral valve (MV) surgery improves survival and may be 
      an alternative to heart transplantation in this group of patients.The aim of the 
      study was to retrospectively analyze the early and mid-term clinical results 
      after MV repair resp. replacement in patients with moderate-severe to severe SMI 
      and left ventricular ejection fraction (LVEF) below 35%. METHODS: We investigated 
      40 patients with poor LVEF (mean, 28 +/- 5%) and SMI who underwent MV repair (n = 
      26) resp. replacement (n = 14) at the University Hospital Muenster from January 
      1994 to December 2005. All patients were on maximized heart failure medication. 6 
      pts. had prior coronary artery bypass grafts (CABG). Twenty-seven patients were 
      in New York Heart Association (NYHA) class III and 13 were in class IV. Eight 
      patients were initially considered for transplantation. During the operation, 14 
      pts had CABG for incidental disease and 8 had tricuspid valve repair. Follow-up 
      included echocardiography, ECG, and physician's examination and was completed in 
      90% among survivors. Additionally, the late results were compared with the 
      survival after orthotope heart transplantation (oHTX) in adults with ischemic or 
      dilated cardiomyopathies matched to the same age and time period (148 patients). 
      RESULTS: Three operative deaths (7.5%) occurred as a result of left ventricular 
      failure in one and multiorgan failure in two patients. There were 14 late deaths, 
      2 to 67 months after MV procedure. Progress of heart failure was the main cause 
      of death. 18 patients who were still alive took part on the follow-up 
      examination. At a mean follow-up of 50 +/- 34 (2-112) months the NYHA class 
      improved significantly from 3.2 +/- 0.5 to 2.2 +/- 0.4 (p < 0.001). The LVEF 
      improved significantly from 29 +/- 5% to 39 +/- 16 (p < 0.05). There were no 
      differences in survival after MV repair or replacement. The 1-, 3-, 5-year 
      survival rates in the study group were 80%, 58% and 55% respectively. In the 
      group of patients after oHTX the survival was accordingly 72%, 68%, 66% (p > 
      0.05). CONCLUSION: High risk mitral valve surgery in patients with cardiomyopathy 
      and SMI offers a real mid-term alternative method of treatment of patients in 
      drug refractory heart failure with similar survival in comparison to heart 
      transplantation.
FAU - Rukosujew, Andreas
AU  - Rukosujew A
AD  - Department of Thoracic and Cardiovascular Surgery, University Hospital Muenster, 
      Germany. andreas.rukosujew@ukmuenster.de.
FAU - Klotz, Stefan
AU  - Klotz S
FAU - Welp, Henryk
AU  - Welp H
FAU - Bruch, Christian
AU  - Bruch C
FAU - Ghezelbash, Farshad
AU  - Ghezelbash F
FAU - Schmidt, Christoph
AU  - Schmidt C
FAU - Weber, Raluca
AU  - Weber R
FAU - Hoffmeier, Andreas
AU  - Hoffmeier A
FAU - Sindermann, Jurgen
AU  - Sindermann J
FAU - Scheld, Hans H
AU  - Scheld HH
LA  - eng
PT  - Journal Article
DEP - 20090717
PL  - England
TA  - J Cardiothorac Surg
JT  - Journal of cardiothoracic surgery
JID - 101265113
SB  - IM
MH  - Aged
MH  - Cause of Death
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Transplantation/mortality
MH  - Heart Valve Prosthesis Implantation/*mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/surgery
MH  - Mitral Valve Insufficiency/*complications/diagnosis/mortality/*surgery
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Stroke Volume
MH  - Survival Analysis
MH  - Survival Rate
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/*complications/diagnosis/mortality/*surgery
PMC - PMC2721830
EDAT- 2009/07/18 09:00
MHDA- 2009/09/02 06:00
PMCR- 2009/07/17
CRDT- 2009/07/18 09:00
PHST- 2008/10/13 00:00 [received]
PHST- 2009/07/17 00:00 [accepted]
PHST- 2009/07/18 09:00 [entrez]
PHST- 2009/07/18 09:00 [pubmed]
PHST- 2009/09/02 06:00 [medline]
PHST- 2009/07/17 00:00 [pmc-release]
AID - 1749-8090-4-36 [pii]
AID - 10.1186/1749-8090-4-36 [doi]
PST - epublish
SO  - J Cardiothorac Surg. 2009 Jul 17;4:36. doi: 10.1186/1749-8090-4-36.