Related Experiment Videos
Surgical treatment of dilated cardiomyopathy with conventional techniques
A M Calafiore1, S Gallina, M Contini
1Department of Cardiac Surgery, University G. D'Annunzio, San Camillo de' Lellis Hospital, Chieti, Italy. calafiore@unich.it
Insights
For dilated cardiomyopathy (DCMP) patients ineligible for transplant, isolated mitral valve surgery offers the best outcomes. Patient selection is crucial for survival, with better results seen in those with normal or moderately impaired right ventricular function.
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Failure Management
Background:
- Dilated cardiomyopathy (DCMP) presents significant challenges in non-transplant eligible patients.
- Functional mitral regurgitation is a common complication in DCMP, impacting prognosis.
- Surgical interventions aim to improve outcomes in these complex patients.
Purpose of the Study:
- To evaluate the surgical outcomes of different conventional techniques for DCMP in non-transplant candidates.
- To compare the efficacy of isolated mitral valve surgery, Batista operation, and exclusion of akinetic areas.
- To identify factors influencing early mortality and long-term survival.
Main Methods:
- Retrospective review of 66 non-transplant eligible DCMP patients undergoing surgery between 1990-1998.
- Patients stratified into Group A (normal/moderate RV function) and Group B (severe RV dysfunction).
- Surgical procedures included isolated mitral valve surgery (n=30), Batista operation (n=21), and exclusion of akinetic areas (n=15).
Main Results:
- Isolated mitral valve surgery showed 0% early mortality in Group A vs. 50% in Group B, with 5-year survival of 81.8% (A) vs. 37.5% (B).
- Batista operation had 23.1% early mortality in Group A vs. 75% in Group B, with 2-year survival of 61.5% (A) vs. 25.0% (B).
- Exclusion of akinetic areas had 18.2% early mortality in Group A vs. 100% in Group B.
Conclusions:
- Patient selection is paramount for early mortality and late survival in DCMP surgical treatment.
- Isolated mitral valve surgery, when feasible, yields the best early and late results.
- Group A patients consistently demonstrated superior outcomes across all surgical cohorts.
Objective:
We review our surgical experience using different conventional surgical techniques in the surgical treatment of the dilated cardiomyopathy (DCMP) in non-transplant eligible patients.
Methods:
In this series we included patients who fit the following criteria: ejection fraction < 35%; end diastolic volume > or = 110 ml/m2; enlargement of the base of the heart (maximal mitral diameter > or = 22 mm/m2) with functional mitral regurgitation; mitral surgery to be performed in every case. Moreover, two groups were considered. (A) Normal or moderately impaired right ventricular function; PAP < 45 mmHg; elective or semielective surgery. (B) Severely impaired right ventricular function; PAP > or = 45 mmHg; severe organ failure; dependency on IABP and/or inotropes; need of ICU stay. From January 1990 to September 1998, 66 patients underwent isolated mitral valve surgery (n = 30); in the remaining 36 the Batista operation (n = 21) or exclusion of akinetic areas (n = 15) were associated. The etiology was ischemic in 42, idiopathic in 23 and post-valvular in one.
Results:
When isolated mitral valve surgery was performed, early mortality in group A (n = 22) was 0, in group B (n = 8) 50%. Overall 5-year survival was 70.0 +/- 8.4. in group A 81.8 +/- 8.2, and in group B 37.5 +/- 17.1. When the Batista operation was performed, early mortality in group A (n = 13) was 23.1%, in group B (n = 8) 75%. Overall 2-year survival was 42.9 +/- 10.8 in group A 61.5 +/- 13.5 and in group B 25.0 +/- 15.3. When akinetic areas were excluded, early mortality in group A (n = 11) was 18.2% and in group B (n = 4) 100%. Overall 1-year survival was 53.3 +/- 12.9, in group A 72.7 +/- 13.4.
Conclusion:
Group A patients have better results in every cohort of patients considered. Even if patients selection seems to be the most important variable for early mortality and late survival, isolated mitral valve surgery, when feasible, provides the best early and late results.