PMID- 22111346
OWN - NLM
STAT- MEDLINE
DCOM- 20120105
LR  - 20111124
IS  - 0021-5252 (Print)
IS  - 0021-5252 (Linking)
VI  - 64
IP  - 11
DP  - 2011 Oct
TI  - [Long-term results and analysis of multiple surgical approaches for ischemic 
      cardiomyopathy with left ventricular reconstruction, including scarred 
      endocardiectomy for arrhythmia therapy, and mitral valve surgery].
PG  - 1007-13
AB  - Among 73 patients with ischemic cardiomyopathy [ejection fraction (EF) < 40%, 
      left ventricular end systolic volume index (LVESVI) > 60 ml/m2], 65 patients with 
      large scar underwent left ventricular reconstruction (LVR) including scarred 
      endocardiectomy against arrhythmia and 13 with 3 + mitral regurgitation (MR) 
      mitral valve surgery [mitral annular plasty (MAP): n = 9, mitral valve 
      replacement (MVR): n = 4]. Eight-year survival including 1 perioperative death 
      (1.4%) was 773% without death due to arrhythmia. 69 survivors revealed 
      significant improvement in New York Heart Association (NYHA) class, and lefe 
      ventricular (LV) function in pulmonary artery pressure (PAP) and EF. LV volume 
      significantly reduced from 103.6 to 57.5 ml/m2 in LVESVI (44% volume reduction) 
      [p < 0.0001]. Postoperative LV shape became significantly spherical [eccentricity 
      index (EI) closer to 0], however, MR grade was significantly reduced from 2.0 to 
      1.6 (p < 0.0003). Freedom from all deaths including hospitalization for cardiac 
      causes was 71.1% at 8 years. One patient required implantable cardioverter 
      defibrillator (ICD) for spontaneous ventricular tachycardia (VT). Multivariate 
      Cox's regression model showed that preoperative large left ventricular end 
      diastolic volume index (LVEDVI) [hazard ratio (HR) 1.02], postoperative large 
      LVESVI (HR 1.03) and preoperative high NYHA class (HR 3.05) were significant risk 
      factors affecting all deaths including hospitalization for cardiac causes. Of 24 
      patients with 2.5 + MR, mitral valve surgery (MAP, MVR or MAP + LVR) demonstrated 
      significant improvement of MR (3.6 to 1.3 in MAP/MVR and 3.5 to 1.0 in MAP + LVR) 
      compared with isolated LVR (2.6 to 2.2), although, there was no significant 
      change in LV volume reduction. Our surgical approach to ischemic cardiomyopathy 
      revealed excellent long-term results without death due to arrhythmia. Risk factor 
      analysis recommended earlier and more aggressive surgical approach to achieve 
      both LV volume reduction, MR and arrhythmia control.
FAU - Cho, Yasunori
AU  - Cho Y
AD  - Department of Cardiovascular Surgery, Tokai University, Isehara, Japan.
FAU - Ueda, Toshihiko
AU  - Ueda T
LA  - jpn
PT  - English Abstract
PT  - Journal Article
PL  - Japan
TA  - Kyobu Geka
JT  - Kyobu geka. The Japanese journal of thoracic surgery
JID - 0413533
SB  - IM
MH  - Adult
MH  - Aged
MH  - Arrhythmias, Cardiac
MH  - Cardiomyopathy, Dilated/mortality/*surgery
MH  - Endocardium/surgery
MH  - Female
MH  - Heart Ventricles/*surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/surgery
MH  - Mitral Valve Insufficiency/surgery
MH  - Myocardial Ischemia/complications
MH  - Treatment Outcome
EDAT- 2011/11/25 06:00
MHDA- 2012/01/06 06:00
CRDT- 2011/11/25 06:00
PHST- 2011/11/25 06:00 [entrez]
PHST- 2011/11/25 06:00 [pubmed]
PHST- 2012/01/06 06:00 [medline]
PST - ppublish
SO  - Kyobu Geka. 2011 Oct;64(11):1007-13.