title: Mitral valve annuloplasty and myocardial revascularization in the treatment of ischemic dilated cardiomyopathy.
abstract: The aim of this study was to examine perioperative mortality and morbidity and midterm results in patients undergoing coronary bypass graft and mitral valve annuloplasty with advanced dilated cardiomyopathy. Sixty-one patients with ischemic dilated cardiomyopathy underwent coronary artery bypass grafting and mitral valve annuloplasty between January 1998 and December 2003. Patients eligible for revascularization that presented a mild or more severe mitral valve regurgitation at echocardiography (effective regurgitant orifice > 0.2 cm(2)) were considered for annuloplasty with a Cosgrove ring. New York Heart Association class (NYHA) III/IV was present in 40 patients (66%) and Canadian Cardiovascular Society class III-IV in 19 (31%). A previous acute myocardial infarction was reported in 48 patients (79%). The mean number of graft anastomoses was 2.5 +/- 0.7 and the left internal mammary artery was used in 49 patients (80%). In-hospital mortality was 4.9% (3 patients), due to unsuccessful weaning from cardiopulmonary bypass, multiple organ failure, and stroke, respectively. Left ventricle ejection fraction improved from 28.9% +/- 5.2% preoperatively to 35.4% +/- 8.1% at follow-up (P = 0.0001) and a significant reduction in NYHA III/IV was detected: from 40 patients preoperatively (66%) to 14 (31%) at follow-up (P = 0.031). Midterm cardiac-related mortality rate was 3.4%. In our experience combined coronary artery bypass grafting and ring annuloplasty for ischemic dilated cardiomyopathy can be performed with acceptable risks for in-hospital mortality and morbidity. Midterm results show a good survival rate and a durable functional improvement in this subset of patients.
authors.affiliation: Cardiac Surgery Department, University of Parma, Parma, Italy. francesconicolini@libero.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Nicolini
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Zoffoli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cagnoni
authors.forename: Andrea
authors.initials: A
authors.lastname: Agostinelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Colli
authors.forename: Claudio
authors.initials: C
authors.lastname: Fragnito
authors.forename: Bruno
authors.initials: B
authors.lastname: Borrello
authors.forename: Cesare
authors.initials: C
authors.lastname: Beghi
authors.forename: Tiziano
authors.initials: T
authors.lastname: Gherli
mesh_terms: D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001026:Coronary Artery Bypass; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D007558:Italy; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012720:Severity of Illness Index; D013318:Stroke Volume; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery