Surgical treatment of heart failure in patients with primary and ischemic dilated cardiomyopathy.
OBJECTIVE
The aim of this study was to show hemodynamic and clinical improvement of heart failure after reductive annuloplasty of double (mitral and tricuspid) orifices (RADO) in the treatment of ischemic (IDCM) and primary (PDCM) dilated cardiomyopathy.


METHODS
From November 1986 to July 15, 2002, 341 patients underwent operations for dilated cardiomyopathy. The IDCM group consisted of 231 patients (68%) with a mean ejection fraction (EF) of 23.3%. From July 1991 to July 15, 2002, the 110 patients in the PDCM group (mean EF, 22.9%) underwent such operations.


RESULTS
The postoperative 30-day mortality rate was 5.9% for the entire patient population, 7.3% for the IDCM group, and 2.7% for the PDCM group. Follow-up survival rates were 61.5% +/- 4.0% at 5 years and 38.2% +/- 8.0% at 14 years for the IDCM group and 43.9% +/- 5.6% at 5 years and 21.3% +/- 8.5% at 10 years for the PDCM group.


CONCLUSIONS
RADO corrects remodeling of the fibrous skeleton of the heart, changes the spherical geometry of the left ventricle, improves the hemodynamic action of the left and right ventricles, and slows down the progression of heart failure. We recommend the RADO procedure as an important associated procedure in the surgical treatment of IDCM and as a new surgical alternative for treating the early stage of PDCM immediately after the first decompensation.
Radovanovic
Ninoslav D
ND
University Clinic of Cardiovascular Surgery, Novi Sad, Yugoslavia. mradov@eunet.yu
Petrovic
Ljuborad V
LV
Mihajlovic
Bogoljub B
BB
Kovac
Marko A
MA
Potic
Zoran R
ZR
Zorc
Marijeta R
MR
D000293:Adolescent; D000328:Adult; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D013318:Stroke Volume; D015996:Survival Rate; D014262:Tricuspid Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*