TY - JOUR
T1 - Ischemic mitral regurgitation
T2 - Intraventricular papillary muscle imbrication without mitral ring during left ventricular restoration
AU - Menicanti, L.
AU - Di Donato, M.
AU - Frigiola, A.
AU - Buckberg, G.
AU - Santambrogio, C.
AU - Ranucci, M.
AU - Santo, D.
PY - 2002/6/1
Y1 - 2002/6/1
N2 - Objectives: Functional mitral regurgitation in ischemic cardiomyopathy carries a poor prognosis, and its surgical management remains problematic and controversial. The aim of this study was to report the results of our surgical approach to patients who have had myocardial infarctions and have ventricular dilatation, mitral regurgitation, reduced pump function, pulmonary hypertension and coronary artery disease. This surgical approach consists of endoventricular mitral repair without prosthetic ring, ventricular reconstruction with or without patch, and coronary artery bypass grafting. Patients: Forty-six patients (aged 64 ± 10 years) with previous anterior transmural myocardial infarction and mitral regurgitation comprised the study group. Indication for surgery was heart failure in 93% of cases; 25 patients were in New York Heart Association functional class IV and 17 were in class III. Mitral regurgitation was moderate to severe in 32 cases (69%). Results: All patients underwent coronary artery bypass grafting, with a mean of 3.2 ± 1.3 grafts. Associated aortic valve replacement was performed in 4 cases. Global operative mortality rate was 15.2%. End-diastolic and end-systolic volumes significantly decreased after surgery (from 140 ± 40 to 98 ± 36 mL/m2 and from 98 ± 32 to 63 ± 22 mL/m2, respectively, P = .001). Systolic pulmonary pressure decreased significantly (from 55 ± 13 to 43 ± 16 mm Hg, P = .001). Ejection fraction did not change significantly. Postoperative mitral regurgitation was absent or minimal in 84% of cases; 1 patient had severe mitral regurgitation necessitating valve replacement. New York Heart Association functional class significantly improved. The mean preoperative functional class was 3.4 ± 0.6 (median 3, range 2-4); after the operation, this decreased to 1.9 ± 0.7 (median 2, range 1-3, P <.001). Cumulative survival at a 30-month follow-up was 63%. Conclusions: Our aggressive, combined surgical approach is aimed at correcting the three components of ischemic cardiomyopathy: relieving ischemia, reducing left ventricular wall tension by decreasing left ventricular volumes, and reducing volume overload and pulmonary hypertension by repairing the mitral valve. Despite a relatively high perioperative mortality rate, surviving patients benefitted from the operation, with improved clinical functional class and thus quality of life.
AB - Objectives: Functional mitral regurgitation in ischemic cardiomyopathy carries a poor prognosis, and its surgical management remains problematic and controversial. The aim of this study was to report the results of our surgical approach to patients who have had myocardial infarctions and have ventricular dilatation, mitral regurgitation, reduced pump function, pulmonary hypertension and coronary artery disease. This surgical approach consists of endoventricular mitral repair without prosthetic ring, ventricular reconstruction with or without patch, and coronary artery bypass grafting. Patients: Forty-six patients (aged 64 ± 10 years) with previous anterior transmural myocardial infarction and mitral regurgitation comprised the study group. Indication for surgery was heart failure in 93% of cases; 25 patients were in New York Heart Association functional class IV and 17 were in class III. Mitral regurgitation was moderate to severe in 32 cases (69%). Results: All patients underwent coronary artery bypass grafting, with a mean of 3.2 ± 1.3 grafts. Associated aortic valve replacement was performed in 4 cases. Global operative mortality rate was 15.2%. End-diastolic and end-systolic volumes significantly decreased after surgery (from 140 ± 40 to 98 ± 36 mL/m2 and from 98 ± 32 to 63 ± 22 mL/m2, respectively, P = .001). Systolic pulmonary pressure decreased significantly (from 55 ± 13 to 43 ± 16 mm Hg, P = .001). Ejection fraction did not change significantly. Postoperative mitral regurgitation was absent or minimal in 84% of cases; 1 patient had severe mitral regurgitation necessitating valve replacement. New York Heart Association functional class significantly improved. The mean preoperative functional class was 3.4 ± 0.6 (median 3, range 2-4); after the operation, this decreased to 1.9 ± 0.7 (median 2, range 1-3, P <.001). Cumulative survival at a 30-month follow-up was 63%. Conclusions: Our aggressive, combined surgical approach is aimed at correcting the three components of ischemic cardiomyopathy: relieving ischemia, reducing left ventricular wall tension by decreasing left ventricular volumes, and reducing volume overload and pulmonary hypertension by repairing the mitral valve. Despite a relatively high perioperative mortality rate, surviving patients benefitted from the operation, with improved clinical functional class and thus quality of life.
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U2 - 10.1067/mtc.2002.121677
DO - 10.1067/mtc.2002.121677
M3 - Article
C2 - 12063449
AN - SCOPUS:0036622491
VL - 123
SP - 1041
EP - 1050
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
SN - 0022-5223
IS - 6
ER -