Update on mitral repair in dilated cardiomyopathy.
نویسندگان
چکیده
Heart failure is one of the leading causes of hospitalization worldwide. Mitral regurgitation (MR) is a known complication of end-stage cardiomyopathy and is associated with a poor prognosis due to progressive mitral annular dilation. A vicious cycle of continuing volume overload, ventricular dilation, progression of annular dilation, increased LV wall tension, and worsening of MR and CHF occur. Commonly, these patients were managed medically with diuretics and afterload reduction, and frequently with mitral valve replacement, both of which have poor long term survival in patients with CHF and MR. Over a 10-year period we prospectively studied over 200 patients with cardiomyopathy and severe MR who underwent mitral valve repair utilizing an undersizing overcorrecting annuloplasty ring. The mortality was low with one intraoperative death and eight 30-day mortalities. There were 26 late deaths; 2 of these patients had progression of heart failure and underwent transplantation. The 1-, 2-, and 5-year actuarial survivals have been 82%, 71%, and 52%, respectively. The NYHA class has improved for all patients from a preoperative mean of 3.2 +/- 0.2 to 1.8 +/- 0.4 postoperatively. All patients demonstrated improvement in ejection fraction, cardiac output, and end diastolic volumes with a reduction in sphericity index and regurgitant volume at 2 years post operation. All of the observed changes contribute to reverse remodeling and restoration of the normal left ventricular geometry. Mitral valve repair is a safe and effective operative intervention that corrects MR and offers a new strategy for patients with MR and end-stage cardiomyopathy.
منابع مشابه
Isolated Undersized Mitral Annuloplasty for Functional Mitral Regurgitation in Non-Ischemic Dilated Cardiomyopathy
he appearance of functional mitral regurgitation (MR) predicts poor survival for patients with nonischemic dilated cardiomyopathy (DCM). Therefore, surgical treatment is recognized as crucial for improving life expectancy. Regarding mitral reconstruction in DCM, Bolling et al reported the clinical usefulness of the undersized mitral annuloplasty (MAP) in 1995;1 however, recurrent or persistent ...
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There is an increasing number of patients with mitral regurgitation secondary to dilated cardiomyopathy. Recent data suggest that mitral regurgitation (MR) can be surgically corrected in heart failure with symptomatic improvements and favourable reverse left ventricular remodeling. However, several questions remain to be answered, regarding the optimal management of functional mitral regurgitat...
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عنوان ژورنال:
- Journal of cardiac surgery
دوره 19 5 شماره
صفحات -
تاریخ انتشار 2004