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Long-term Outcome of Mitral Annuloplasty with or without Left Ventricular Restoration Surgery for Idiopathic Dilated Cardiomyopathy
T. Horii1, T. Isomura2, H. Suma3. 1Kagawa University, Kagawa, Japan, 2Hayama Heart Center, Hayama, Japan, 3Cardiovascular Institute Japan, Tokyo, Japan,
BACKGROUND: Mitral annuloplasty (MAP) is a recommended treatment for CHF with mitral regurgitation. However, idiopathic DCM with severely enlarged left ventricle is often not effectively treated by only MAP. We examined our long-term outcome of left ventricular restoration surgery (LVR) in conjunction with MAP.
METHODS: Eighty three pts with idiopathic DCM underwent MAP with or without LVR. We performed LVR according to the echocardiographic findings to exclude the most damaged part of LV by partial left ventriculectomy or septal anterior ventricular exclusion operation.
RESULTS: Preoperative NYHA class was III in 47 pts and IV in 36 pts. In elective basis, 33 pts underwent MAP without LVR (LVR-) and 40 pts with LVR (LVR+), PLV in 19 pts and SAVE in 21 pts. Hospital mortality in elective operations was 3% (1/33) in LVR- and 7.5% (3/40) in LVR+. LV parameters showed in table. There was a difference in the survival rate between two groups with enlarged LV(p=0.0459, figure).
CONCLUSIONS: MAP is an effective treatment for DCM with CHF. Once LV is everely enlarged, LVR is a preferable combination with MAP. Proper selection of the surgical mode, MAP, PLV, SAVE, or a combination, may improve a long-term outcome of non-transplant surgery for DCM.
Perioperative LV parameters of ESVI > 120 ml/m2 | | LV EF % | LV Dd mm | LV ESVI ml/m2 | LV ESVI ml/m2 | | LVR - group | Pre | 25.5±6.8 | 70.4±7.1 | 152±52 | 152±52 | | Post | 24.3±7.9 | 67.3±11.4 | 144±71 | 144±71 | | LVR + group | Pre | 22.6±7.3 | 81.1±7.7 | 175±46 | 175±46 | | Post | 28.0±7.5* | 73.2±7.2* | 130±51* | 130±51* | | * indicates p<0.01 versus pre in each group | 
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