Left Ventricle Restoration in End Stage Ischemic Dilated Cardiomyopathy

Objective: Patients with end stage ischemic dilated cardiomyopathy (IsDCM) exhibit extensive remodeling of the left ventricle, and significant mitral and tricuspid regurgitation. We investigated if implantation of the artificial mitral valve with preservation of the native mitral valve could be used as a method combined with tricuspid annuloplasty and complete myocardial revascularization in end stage IsDCM.

Materials and Methods: There were 31 patients (26 males, 5 females) with end stage IsDCM (NYHA III/IV). All patents had significant mitral and tricuspid regurgitation, mean ejection fraction below 30% (25.6±3.1%), and mean left ventricle end-diastolic internal diameter greater than 7.0 cm (7.3±0.3 cm) with coaptation depth of the mitral valve significantly greater than 1.1cm (STS ?risk of mortality? score = 22.04±1.5%; Euroscore II = 7.04 ± 1.02). In addition to complete myocardial revascularization biological or mechanical artificial valve was implanted in 27 and 4 patients respectively. Modified De Vega tricuspid annuloplasty was performed in all patients.

Results: There was no postoperative 30-day mortality. Significant reverse remodeling of the heart was achieved measured by decrease of the end-systolic sphericity index (84.2 vs. 68.9%) and improved ejection fraction (26.6 vs. 32.6%). Clinical status of the patient was significantly improved immediately after procedure, and was stable 12 month after surgery. Long term results showed survival rate after 5 years of 83.33%.

Conclusion: Reverse remodeling of the left ventricle with implantation of the artificial mitral valve, suture annuloplasty of the tricuspid valve and complete myocardial revascularization could be successfully applied in patients with end stage IsDCM. Our method should not be recognized as a valve repair, but ventricular repair as well and could be used as a bridge to heart transplantation or even destination therapy in selective patients.

Fig. 1 Reverse remodeling of the left ventricle in IsDCM SF = sphericity index

Fig. 2 Follow up study NYHA class

References

1. Radovanović N, Mihajlović B, Selestianskỳ J, et al. Reductive annuloplasty of double orifices in patients with primary dilated cardiomyopathy. Ann Thorac Surg 2002;73(3):751–755 PubMed

2. Jonjev ZS, Mijatov M, Fabri M, Popović S, Radovanović ND. Systematic reductive annuloplasty of the mitral and tricuspid valves in patients with end-stage ischemic dilated cardiomyopathy. J Card Surg 2007;22(2):111–116 PubMed

3. 3. Jonjev ZS, Lavac J, Fabri M, Radovanovic N, Ilic L. 23rd. Dilated Cardiomyopathy: Is Suture Annuloplasty Realy Forgotten? EACTS Meeting, Vienna, Austria 2009; Interactive CardioVascular and Thoracic Surgery, 9(Supp. 2): S88

Publikationsverlauf

Artikel online veröffentlicht:
10. Juni 2022