Surgical Treatment of Heart Failure in Patients with Primary and Ischemic Dilated Cardiomyopathy
Objective: The aim of this study was to show hemodynamic and clinical improvement of heart failure after reductive annuloplasty of double (mitral and tricuspid) orifices (RADO) in the treatment of ischemic (IDCM) and primary (PDCM) dilated cardiomyopathy.
Materials and Methods: From November 1986 to July 15, 2002, 341 patients underwent operations for dilated cardiomyopathy. The IDCM group consisted of 231 patients (68%) with a mean ejection fraction (EF) of 23.3%. From July 1991 to July 15, 2002, the 110 patients in the PDCM group (mean EF, 22.9%) underwent such operations.
Results: The postoperative 30-day mortality rate was 5.9% for the entire patient population, 7.3% for the IDCM group, and 2.7% for the PDCM group. Follow-up survival rates were 61.5% ± 4.0% at 5 years and 38.2% ± 8.0% at 14 years for the IDCM group and 43.9% ± 5.6% at 5 years and 21.3% ± 8.5% at 10 years for the PDCM group.
Conclusion: RADO corrects remodeling of the fibrous skeleton of the heart, changes the spherical geometry of the left ventricle, improves the hemodynamic action of the left and right ventricles, and slows down the progression of heart failure. We recommend the RADO procedure as an important associated procedure in the surgical treatment of IDCM and as a new surgical alternative for treating the early stage of PDCM immediately after the first decompensation.
Radovanovic N, Petrovic Lj, Zorc M, et al. 2002. Changes in left ventricular morphology and function in end-stage dilated cardiomyopathy after reductive annuloplasty of double mitral and tricuspid orifices. J Card Surg 17:201-4.nRadovanovic N, Vuk F, Petrovic Lj, et al. 1995. Correction of mitral and tricuspid regurgitation improves hemodynamic and clinical status in the patients with primary dilated cardiomyopathy [abstract]. J Am Coll Cardiol February 1995 Special Issue:74A.nRadovanovic N, Zecevic D, Vuk F, et al. 1993. New surgical method of treatment of patients with dilatative cardiomyopathy in pre-terminal phase [abstract]. In: XV Congress of the European Society of Cardiology meeting program; 1993 29 Aug-2 Sep; Nice, France. Abstract nr 458.nRahimtoola SH. 1989. The hibernating myocardium. Am Heart J 117:211-21.nRankin JS, Feneley MP, Hickey MS, et al. 1988. A clinical comparison of mitral valve repair versus valve replacement in ischemic mitral regurgitation. J Thorac Cardiovasc Surg 95:165-77.nRichardson P, McKenna W, Bristow M, et al. 1996. Report of the 1995 World Health Organization/International Society and Federation of Cardiology task force on the definition and classification of cardiomyopathies. Circulation 93:841-2.nSheikh KH, Bengtson JR, Rankin JS, de Bruijn NP, Kisslo J. 1991. Intraoperative transesophageal Doppler color flow imaging used to guide patient selection and operative treatment of ischemic mitral regurgitation. Circulation 84:594-604.nWeber KT, Sun Y, Ratajska A, et al. 1995. Structural remodeling of the myocardium in ischemic and hypertensive heart disease. In: Dhalla NS, Beamish RE, Takeda N, et al, editors. The failing heart. Philadelphia, Pa: Lippincott-Raven. p 163-86.nRadovanovic N, Mihajlovic B, Selestiansky J, et al. 2002. Reductive annuloplasty of double orifices in patients with primary dilated cardiomyopathy. Ann Thorac Surg 73:751-5.nDavid TE, Komeda M, Pollick C, Burns RJ. 1989. Mitral valve annuloplasty: the effect of the type on left ventricular function. Ann Thorac Surg 47:524-8.nLillehei CW. 1995. New ideas and their acceptance: as it has related to preservation of chordae tendinea and certain other discoveries. J Heart Valve Dis 4(suppl 2):S106-14.nMcGoon DC. 1960. Repair of mitral insufficiency due to ruptured chordae tendineae. J Thorac Cardiovasc Surg 39:357-62.nMoreira LF, Stolf NA, Bocchi EA, et al. 1990. Latissimus dorsi cardiomyoplasty in the treatment of patients with dilated cardiomyopathy. Circulation 82:IV-257-63.nOury JH, Cleveland JC, Duran CG, Angell WW. 1994. Ischemic mitral valve disease: classification and systemic approach to management. J Card Surg 9(suppl):262-73.nCohn JN. 1995. Prevention and reversal of ventricular remodeling: experimental and clinical observations. In: Dhalla NS, Beamish RE, Takeda N, et al, editors. The failing heart. Philadelphia, Pa: Lippincott-Raven. p 193-206.nCarpentier A. Mitral valve annuloplasty. Ann Thorac Surg 49:508-9.nBolling SF, Pagani FD, Deeb GM, Bach DS. 1998. Intermediate-term outcome of mitral reconstruction in cardiomyopathy. J Thorac Cardiovasc Surg 115:381-6.nBolling SF, Deeb GM, Brunsting LA, Bach DS. 1995. Early outcome of mitral valve reconstruction in patients with end-stage cardiomyopathy. J Thorac Cardiovasc Surg 109:676-83.nDor V, Di Donato M. 1997. Ventricular remodeling in coronary artery disease. Curr Opin Cardiol 12:533-7.nJugdutt BI. 1995. Modification of left ventricular remodeling after myocardial infarction. In: Dhalla NS, Beamish RE, Takeda N, et al, editors. The failing heart. Philadelphia, Pa: Lippincott-Raven. p 231-46.nKay GL, Kay JH, Zubiate P, Yokoyama T, Mendez M. 1986. Mitral valve repair for mitral regurgitation secondary to coronary artery disease. Circulation 74:I-88-98.nZorc M, Vraspi-Porenta O, Zorc-Pleskovic R, Radovanovic N, Petrovic D. 2003. Apoptosis of myocytes and proliferation markers as prognostic factors in end-stage dilated cardiomyopathy. Cardiovasc Pathol 12:36-9.nHausmann H, Siniawski H, Hotz H, et al. 1997. Mitral valve reconstruction and mitral valve replacement for ischemic mitral insufficiency. J Card Surg 12:8-14.nFuchs S, Rozeman Y, Pollak A, et al. 1998. Lack of improvement of mitral regurgitation after isolated coronary angioplasty of the left circumflex artery [abstract]. J Am Coll Cardiol 31(suppl C):211.n
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