Left ventricular reconstruction with or without mitral annuloplasty.
OBJECTIVE
The aim of this study was to review characteristics of patients undergoing left ventricular reconstruction (LVR) with or without mitral annuloplasty (MAP) for postinfarction ventricular remodeling.


METHODS
Forty-seven patients were divided into two groups: LVR (LVR group, n = 22) and LVR with MAP (LVRM group, n = 25). Echocardiographic parameters including left ventricular (LV) dimensions, LV end-diastolic and end-systolic volume indexes, and LV ejection fraction (LVEF) at immediate and midterm postoperative stages were evaluated. The perioperative contributing factors to all deaths and death from congestive heart failure (CHF) were analyzed in all 47 patients.


RESULTS
Patients in the LVRM group had greater preoperative LV dimension and volume, and significantly lower LVEF, with notably frequent use of intra-aortic balloon pumping. All postoperative deaths occurred within 1 year from surgery. The LV end-diastolic volume > 110 ml/m2 and creatinine > 1.2 mg/dl were significant preoperative contributing factors to all deaths, and the latter was to CHF deaths.


CONCLUSIONS
The coexistence of ischemic mitral regurgitation with LV dilatation required more aggressive surgical approaches for the patients with more impaired LV function. More intensive postoperative management is required for patients with enlarged hearts and renal dysfunctions.
Ueno
Tetsuya
T
Department of Cardiovascular Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Sakata
Ryuzo
R
Iguro
Yoshifumi
Y
Yamamoto
Hiroyuki
H
Ueno
Masahiro
M
Ueno
Takayuki
T
Matsumoto
Kazuhisa
K
Hisashi
Yosuke
Y
Tei
Chuwa
C
D000368:Aged; D001026:Coronary Artery Bypass; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D011474:Prosthesis Design; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling