Efficacy of modified endoventricular circular patch plasty in ischemic cardiomyopathy--innovative delimitation technique using integrated myocardial management.
BACKGROUND
Optimal delimitation is one of the most important factors for successful endoventricular circular patch plasty (EVCPP). The aim of this study was to determine whether our modification as an application of integrated myocardial management enables reproducible delimitation and feasible myocardial protection, resulting in better clinical outcomes for ischemic cardiomyopathy (ICM) patients.


METHODS
Between September 1998 and November 2001, 22 ICM patients underwent EVCPP with coronary artery bypass grafting (CABG) [group I, n = 14] or CABG only [group II, n = 8]. The majority had congestive cardiac failure, and NYHA in groups I and II were 2.9 +/- 0.5 and 2.7 +/- 0.8, respectively. After complete revascularization, delimitation was determined by palpation of the empty beating heart during antegrade warm blood perfusion without unclamping the aorta. The heart was then re-arrested for secure cryotherapy and suturing under single aortic clamping.


RESULTS
There were no in-hospital deaths and no need for mechanical support. Preoperative angiograms in group I showed a lower EF (21.2 +/- 4.0 vs 26.8 +/- 2.6%, P < 0.01) and a more dilated ventricle (LVESVI: 115 +/- 39 vs 73 +/- 15 ml/m2,P < 0.01). In contrast, early postoperative results were comparable between the groups as far as EF (39 +/- 12 vs 43 +/- 9%) and LVESVI (55 +/- 26 vs 54 +/- 11 ml/m2). During follow-up (15 +/- 10 months), freedom from cardiac death was 100%, and 95% of patients were NYHA I or II.


CONCLUSIONS
ICM patients with LV dilation could safely be treated by CABG and EVCPP with modified delimitation technique to regain reduced LV volume and function as good as patients without LV dilation undergoing CABG alone.
Nakamura
Masanori
M
Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan. mnakamura@keijinkai.or.jp
Okamoto
Fumiyuki
F
Hatta
Eiichiro
E
Nakanishi
Katsuhiko
K
Matano
Jun
J
Sakai
Keisuke
K
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D001026:Coronary Artery Bypass; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000601:surgery*; D009204:Myocardial Revascularization; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000601:surgery