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J Thorac Cardiovasc Surg 1998;115:381-388
© 1998 Mosby, Inc.
SURGERY FOR ACQUIRED HEART DISEASE |
From the Sections of Thoracic Surgery and Cardiology, The University of Michigan, Ann Arbor, Mich.
Read at the Twenty-third Annual Meeting of The Western ThoracicSurgical Association, Napa, Calif., June 25-28, 1997.
Received for publication July 8, 1997; revisions requested August 27, 1997; revisions received Oct. 9, 1997; accepted for publication Oct. 9, 1997. Address for reprints: Steven F. Bolling, MD, The University of Michigan Hospitals, Section of Thoracic Surgery, 2120D Taubman Center, Box 0344, Ann Arbor, MI 48109.
Abstract
Objective: Severe mitral regurgitation is a frequent complication of end-stage cardiomyopathy that contributes to heart failure and predicts a poor survival. We studied the intermediate-term outcome of mitral reconstruction in 48 patients who had cardiomyopathy with severe mitral regurgitation and were operated on between June 1993 and June 1997.
Methods: Ages ranged from 33 to 79 years (63 ± 6 years) with left ventricular ejection fractions of 8% to 25% (16% ± 3%). All patients were receiving maximal drug therapy and were in New York Heart Association class III-IV with severe, refractory 4+ mitral regurgitation. Operatively, all 48 had undersized flexible annuloplasty rings inserted, 7 had coronary bypass grafts for incidental disease, 11 had prior bypass grafts, and 11 also had tricuspid valve repair.
Results: One operative death occurred as a result of right ventricular failure. Postoperative transesophageal echocardiography revealed mild mitral regurgitation in 7 patients and no mitral regurgitation in 41. There were 10 late deaths, 2 to 47 months after mitral reconstruction. The 1- and 2-year actuarial survivals have been 82% and 71%. At a mean follow-up of 22 months, the number of hospitalizations for heart failure has decreased, and 1 patient has had heart transplantation. Significantly, New York Heart Association class improved from 3.9 ± 0.3 before the operation to 2.0 ± 0.6 after the operation. Twenty-four months after the operation, left ventricular volume and sphericity have decreased, whereas ejection fraction and cardiac output have increased.
Conclusion: Whether this favorable modification of left ventricular function and geometry will persist remains unknown. However, mitral repair for cardiomyopathy with mitral regurgitation allows new strategies for these patients.
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