title: Noncardioplegic surgery for ischemic mitral regurgitation.
abstract: Twenty-seven consecutive patients underwent surgery for ischemic mitral regurgitation (MR): papillary muscle rupture (1), papillary muscle dysfunction (11) and annular dilatation (15). The grade of MR was moderate or severe, and the ejection fraction (EF) was less than 30% in 8 patients (mean, 43%). Three cases were reoperation and 3 were emergencies. Under ventricular fibrillation (VF) and intermittent aortic cross-clamping at moderate hypothermia, coronary artery bypass grafting (CABG) was performed first, followed by the mitral procedure through a right-sided left atriotomy (repair 21, replacement 6) performed under VF with the heart perfused through the native coronary arteries and CABG grafts. Concomitant procedures were CABG (23), Dor's procedure (5), and tricuspid annuloplasty (3). In one reoperative case with cardiogenic shock, CABG was impossible because of dense adhesions and the patient died just after surgery (hospital mortality, 3.7%). Five patients required intra-aortic balloon pump (IABP) support intraoperatively, but none required prolonged (> or =7 days) inotropic support or IABP use, although the serum concentrations of creatine kinase and its myocardial fraction were elevated remarkably. Other morbid events were refractory ventricular arrhythmia in one case and stroke in another. Median duration of mechanical ventilation and intensive care unit stay was 8 h and 3 days, respectively. Mean EF at hospital discharge was 48%. The extended period of VF was not associated with unfavorable clinical outcomes. Noncardioplegic surgery for ischemic MR was carried out with acceptable mortality and morbidity, and can be a good alternative, especially when clamping the aorta is undesirable.
authors.affiliation: Department of Cardiovascular Surgery, Saitama Medical School, Japan. imanaka@saitama-med.ac.jp
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Imanaka
authors.forename: Shunei
authors.initials: S
authors.lastname: Kyo
authors.forename: Masanori
authors.initials: M
authors.lastname: Ogiwara
authors.forename: Satoshi
authors.initials: S
authors.lastname: Gojo
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kato
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tanabe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohuchi
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Asano
authors.forename: Yuji
authors.initials: Y
authors.lastname: Yokote
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D001026:Coronary Artery Bypass; D003402:Creatine Kinase / Q000097:blood / Q000378:metabolism; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology* / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications* / Q000201:enzymology / Q000601:surgery; D009206:Myocardium / Q000201:enzymology; D012770:Shock, Cardiogenic / Q000209:etiology; D013318:Stroke Volume
chemical_list: D003402:Creatine Kinase