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Surgical treatment of endomyocardial fibrosis
Insights
Endomyocardial fibrosis surgery involving valve replacement offers a chance of survival for severely disabled patients. Despite high operative risks, this procedure improved outcomes for advanced cases.
Area of Science:
- Cardiology
- Cardiac Surgery
- Tropical Medicine
Background:
- Endomyocardial fibrosis (EMF) is a restrictive cardiomyopathy with a high incidence in specific regions like Kerala, India.
- Patients often present with advanced New York Heart Association (NYHA) Functional Class III or IV symptoms.
- Surgical intervention is considered for patients with limited therapeutic options.
Purpose of the Study:
- To evaluate the outcomes of endocardiectomy and atrioventricular valve replacement in patients with endomyocardial fibrosis.
- To identify factors associated with operative mortality.
- To assess long-term survival and complications after surgery.
Main Methods:
- A retrospective analysis of 46 patients with endomyocardial fibrosis who underwent endocardiectomy and atrioventricular valve replacement.
- Procedures were performed between April 1981 and October 1984.
- Data collected included operative mortality, late mortality, and non-fatal thromboembolic episodes.
Main Results:
- Operative mortality within 30 days was 21.7%, and late mortality was 13% over two years.
- Age under 15 years was a significant risk factor for operative mortality (p = .05).
- Two-year survival, including operative mortality, was estimated at 67%; 6 patients experienced non-fatal thromboembolic events.
Conclusions:
- Endocardiectomy with atrioventricular valve replacement is a viable, albeit high-risk, option for functionally disabled patients with endomyocardial fibrosis.
- The procedure offers a potential survival benefit for patients with a previously dismal prognosis.
- Risk stratification, particularly considering age, is crucial for managing operative outcomes.
Abstract:
Forty-six patients with endomyocardial fibrosis underwent endocardiectomy and replacement of tricuspid, mitral, or both atrioventricular valves between April, 1981, and October, 1984, at the Sree Chitra Tirunal Institute, Kerala State, India, which has a high incidence of the disease. Six patients were in New York Heart Association Functional Class III and 40 patients in Class IV. The operative mortality within 30 days of the procedure and late mortality during the first two years postoperation were 21.7% and 13%, respectively. Age under 15 years was a significant correlate of operative mortality (p = .05). Non-fatal thromboembolic episodes occurred in 6 patients during the two years of postoperative observation. The life table estimate of survival inclusive of operative mortality at two years was 67%. Despite high operative mortality, endocardiectomy with atrioventricular valve replacement is advisable for functionally disabled patients with endomyocardial fibrosis whose prognosis otherwise is dismal.