AND LONG -TERM RESULTS AFTER SURGERY FOR ISHEMIC DILATED CARDIOMYOPATHY
WITH MITRAL REGURGITATION
N. Radovanović, S. Ničin, Lj. Petrović, B. Mihajlović, M.
Zorc1, V. Torbica, J. Selestiansky, P. Kovačević, M. Fabri
and M. Popov.
Clinic of Cardiovascular Surgery, Novi Sad, Yugoslavia, Institute
of Histology1, Medical Faculty, Ljubljana, Slovenia
Background: The pathogenic mechanism of
chronic mitral regurgitation is considered to be due to the combination
of papillary muscle dysfunction left ventricular and annular dilatation
and myocardial dyskinesia. These processes lead to remodelling
of the fibrous skeleton of the heart, which is an important part
of remodelling of the left ventricle. We have reviewed our group
of 163 operated patients with chronic ishemic dilated cardiomyopathy
(IDCM), ejection fraction (EF) below 30% and mitral regurgitation.
Methods: There were 163 male (92%) and
15 female patients, aged 34-70, with the mean age of 56,2 years.
The mean EF was 23,0 = 4,9% male, and the mean ventricular diastolic
internal diameter 7,0 cm. Among those, 71% (126/178) had signs
of congestive heart failure before surgical therapy. All patients
had undergone myocardial revascularisation and Reductive Annuloplasty
of Double (mitral and tricuspid) Orifices (RADO). Our technique
preserves normal shape and flexibility of the mitral and tricuspid
valve corrects remodelling of the fibrous skeleton on the base
of the heart and changes the geometry of the left and right ventricle.
Results: Postoperative mortality- 30 days was 5,0% (9/178). Closing
date of the follow-up study was February 15, 1998. The study was
done for 117 patients. The average time of follow-up was 30 months
(0-132). Survival rate was 53,5±5,9% at 5 years and 42,4 ±7,4%
at 10 years
Conclusions: According to our experience
with 178 operated patients, we conclude that this severe group
of patients with dilated cardiomyopathy, ishemic mitral regurgitation
and ejection fraction below 30% can be operated with low operative
risk. After RADO and optimal myocardial revascularisation a significant
improvement in all hemodynamic parameters was observed as well
as good long-term results.