Surgical treatment of secondary atrioventricular heart valve insufficiency in patients with dilated cardiomyopathy
Abstract
Dilated cardiomyopathy (DCM) refers to a heart diseases with an extremely serious clinical course and an unfavorable prognostic for life. The presence of mitral and tricuspid regurgitation (MR and TR) negative impact on the survival of patients with DCM. Eighty-one patients with DCM underwent mitral and tricuspid valves repair for MR and TR during the period from 2007 to 2017 year in Kiev National Amosov institute of cardiovascular surgery.
The average age of patients made up 50±14 years. The disease duration ranged from 4 months to 12 years, an average of 49,4±7,5 months. Based on techniques of surgery and end-diastolic performance index (LVEDDI> 160 ml/m2) studied cohort of patients was divided into two groups. In the first group included 64 (80%) patients with dilated cardiomyopathy who underwent mitral and tricuspid isolated undersized mitral and tricuspid annuloplasty without additional procedures. The second group was 17 (20%) patients with DCM, underwent undersized mitral and tricuspid annuloplasty and the procedure of papillary muscles approximation and suspension. Analysis of the clinical condition and performance tool postoperative examination performed in 74 (91%) patients after 2 years and 56 (70%) patients after 3–5 years after reconstructive operations on atrioventricular valves in patients with dilated cardiomyopathy.
Analyzing survival curves revealed that 5-year survival in the total group of patients after reconstructive surgery for atrioventricular valves was 58 (71.6%) cases, 5-year survival in patients with dilated cardiomyopathy after annuloplasty atrioventricular heart valves was 46 (71.9%) cases, and in patients who undersized mitral and tricuspid annuloplasty and the procedure of papillary muscles approximation and suspension was 12 (70.6%) cases.
References
2. High risk cardiac surgery as an alternative to transplant or mechanical support in patients with end- stage heart failure / Kawajiri H., Manlhiot C., Ross H. et al. // J Thorac Cardiovasc Surg. – DOI: http://dx.doi.org/10.1016/j. jtcvs.2017.03.040
3. Mitral valve surgery in advanced heart failure / Di Salvo T. G., Acker M. A., Dec G. W. et al. // Journal of the American College of Cardiology. – 2010. – Vol. 55. – P. 271–82.
4. Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment / Grigioni F., Enriquez-Sarano M., Zehr K. J. // Circulation. – 2001. – Vol. 103. – P. 1759–64.
5. Mitral valve repair for medically refractory functional mitral regurgitation in patients with end-stage renal disease and advanced heart failure / Kainuma S., Taniguchi K., Daimon T. et al. // Circulation. – 2012. – Vol. 126. – P. 205–13.
6. The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery / Vahanian A., Alfieri O., Andreotti F. et al. // Eur. Heart J. – 2012. – Vol. 33. – P. 2451–96.
7. Деклараційний патент 104083 UA, МПК А61В 17/00(2013.01) Спосіб реконструкції клапанів серця у хворих із дилатаційною кардіоміопатією / Книшов Г. В., Крикунов О. А., Бабочкіна А. Р., Руснак А. О., Буряк Р. В,, Лучинець О. Ф., Ісаєнко В. В; заявник Державна установа «Національний Інститут серцево-судинної хірургії ім. М. М. Амосова Національної академії медичних наук України». – № 2012 11181; заявл. 26.09.12 ; опубл. 25.12.13, бюл. № 24.
