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Feasibility and limitations of mitral valve repair, with or without left ventricular reconstruction in non-ischemic dilated cardiomyopathy

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Title: Feasibility and limitations of mitral valve repair, with or without left ventricular reconstruction in non-ischemic dilated cardiomyopathy
Authors: Shingu, Yasushige Browse this author →KAKEN DB
Ooka, Tomonori Browse this author →KAKEN DB
Katoh, Hiroki Browse this author
Tachibana, Tsuyoshi Browse this author
Kubota, Suguru Browse this author →KAKEN DB
Matsui, Yoshiro Browse this author →KAKEN DB
Keywords: Mitral regurgitation
Mitral valve repair
Non-ischemic dilated cardiomyopathy
Issue Date: Apr-2018
Publisher: Elsevier
Journal Title: Journal of cardiology
Volume: 71
Issue: 4
Start Page: 329
End Page: 335
Publisher DOI: 10.1016/j.jjcc.2017.09.013
Abstract: Background: Although non-transplant surgical interventions for non-ischemic dilated cardiomyopathy (NIDCM) are relatively effective, their feasibility and limitations have not been fully elucidated. The aim of this study was to define the feasibility and limitations of mitral valve repair, with or without surgical ventricular reconstruction for patients with NIDCM in terms of postoperative low cardiac output syndrome (LOS). Methods: Twenty non-transplant candidates (aged 57 ± 13 years) with NIDCM and significant mitral regurgitation had undergone mitral valve repair combined with submitral procedures. Using a 72-mL plastic ellipsoidal sizer, left ventricular reconstruction was performed concomitantly in 14/20 (70%) patients with extremely large ventricles. Total stroke volume, deceleration time of early trans-mitral flow wave, and the slope (Mw) in the preload recruitable stroke-work relationship were assessed using transthoracic echocardiography. LOS was defined as in-hospital death due to heart failure or a cardiac index less than 2.2 L/min/m2 before discharge. Results: There were three in-hospital deaths and four patients with postoperative cardiac index less than 2.2 L/min/m2 [n = 7 (35%), LOS group]. Preoperative total stroke volume, deceleration time, and the Mw were significantly lower in the LOS group compared to those in the non-LOS group; the predicted cut-off values for LOS were 84 mL/beat (p = 0.008), 133 ms (p = 0.015), and 45 erg cm-3 × 10^3 (p = 0.036), respectively. Preoperative left ventricular ejection fraction and ventricular size could not predict postoperative LOS. The one-year survival rate was 0% in the LOS group and 84% in the non-LOS group (p < 0.001). Conclusions: Mitral valve repair, with or without left ventricular reconstruction, could be contraindicated for NIDCM patients with low total stroke volume, deceleration time, and Mw in terms of high postoperative incidence of LOS. For high-risk patients, other therapeutic strategies might be necessary.
Rights: © 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
http://creativecommons.org/licenses/by-nc-nd/4.0/
Type: article (author version)
URI: http://hdl.handle.net/2115/73411
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 新宮 康栄

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