Partial Left Ventriculectomy for Patients with Ischemic Cardiomyopathy
| Autor: | Randas J.V. Batista, Hatsue Ishibashi-Ueda, Jacob Bergsland, Takabumi Fujimura, Akira T. Kawaguchi, Shirosaku Koide |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Adult
Cardiomyopathy Dilated Male Pulmonary and Respiratory Medicine medicine.medical_specialty Heart Ventricles Myocardial Ischemia Severity of Illness Index law.invention Resection Risk Factors law Internal medicine Severity of illness Humans Medicine Cardiac Surgical Procedures Retrospective Studies Partial left ventriculectomy Ischemic cardiomyopathy business.industry Dilated cardiomyopathy Retrospective cohort study Middle Aged medicine.disease Intensive care unit Treatment Outcome medicine.anatomical_structure Cardiology Female Surgery Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | Journal of Cardiac Surgery. 16:145-152 |
| ISSN: | 1540-8191 0886-0440 |
| DOI: | 10.1111/j.1540-8191.2001.tb00500.x |
| Popis: | Background: Partial left ventriculectomy (PLV) has been performed in patients with dilated cardiomyopathy (DCM), but improved myocardial energetics may make PLV useful also for ischemic cardiomyopathy (ICM) unamenablis to conventional treatment. Methods: Of 262 patients undergoing PLV, 94 patients with ICM as the underlying pathology were analyzed and compared with 168 patients with DCM. Results: ICM patients were older (57.3 years vs 50.9 years, p = 0.0001) and heavier (69.7 kg vs 65.9 kg, p = 0.039) than those with DCM, but ventricular end-diastolic and end-systolic dimensions were similar with comparably depressed fractional shortening (16% vs 15%, p = 0.294) and equally severe functional limitation [New York Heart Association (NYHA) Class 3.7 vs 3.6, p = 0.734]. A majority of patients in both groups underwent lateral PLV (76% vs 74%, p = 0.883) with myocardium excised between papillary muscles and simultaneous mitral valvuloplasty (41% vs 74%, p < 0.0001). Because ICM patients required coronary artery bypass grafting (CABG) more frequently (79% vs 0.6%, p < 0.0001), operation was more extensive in terms of bypass time (74 minutes vs 47 minutes, p < 0.0001), percentage requiring cardiac arrest (43% vs 19%, p < 0.0001), and arrest duration (34 minutes vs 28 minutes, p = 0.280), but all had similar resection and postoperative ventricular dimensions. Nonetheless, ICM patients required shorter intensive care unit (ICU) time (4.4 days vs 5.9 days, p = 0.048) and similar postoperative hospital stays, resulting in similar hospital survival rates (69% vs 71%, p = 0.778) and functional capacity in long-term follow-up. Conclusions: Results suggest that PLV can be performed in patients with ICM with comparable risks and benefits as in DCM. Relative efficacy of CABG and mitral repair as compared to volume reduction remains to be studied. |
| Databáze: | OpenAIRE |
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