End-stage cardiomyopathy and secondary mitral insufficiency surgical alternative with prosthesis implant and left ventricular restoration.
BACKGROUND
Secondary mitral insufficiency is a strong risk factor for death in end-stage cardiomyopathy. The possible correction of mitral regurgitation has now been accepted as an alternative to cardiac transplantation in a special subset of patients. We propose a new surgical approach that consists of implantation of a mitral prosthesis that is smaller than the annulus, and preservation and traction of the papillary muscles to reduce sphericity of the left ventricle.


METHODS
Between December 1995 and September 2005, 116 patients with dilated cardiomyopathy underwent this procedure, with the following etiologic factors: ischemic (68), idiopathic (43), Chagas disease (3), viral (1), and postpartum (1). The patients were analyzed according to clinical criteria, echocardiographic findings, and morphology of left ventricle.


RESULTS
All patients were in an end-stage phase, requiring >2 hospital admissions over the past 3 months, despite receiving full medication. Furthermore, seven were in intensive care unit receiving intravenous drugs or intra-aortic balloon counterpulsation, and one was in cardiogenic shock. Hospital mortality was 16.3% (19/116), yet midterm follow-up showed a relatively flat late survival curve, with evidence of improved clinical status, better echocardiographic parameters, and reduction in ventricular sphericity.


CONCLUSIONS
The high early mortality rate related to other clinical conditions at the time of surgery. However, the resultant flat survival after this early interval offers a promising long-term therapeutic alternative for the treatment of patients in refractory heart failure with cardiomyopathy that is associated with moderate or severe secondary mitral regurgitation.
Buffolo
Enio
E
Cardiovascular Surgery Department, Federal University of São Paulo, Paulista School of Medicine, Brazil. enio.buffolo@terra.com.br
Branco
João Nelson R
JN
Catani
Roberto
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006352:Heart Ventricles / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D010210:Papillary Muscles / Q000601:surgery; D019736:Prostheses and Implants; D016019:Survival Analysis; D016896:Treatment Outcome; D014463:Ultrasonography