Selected ventriculoplasty for @entity1000 with advanced XXXX : midterm results and risk analysis.

@entity1 @entity712 @entity339 @entity1000 @entity5707 @entity204
BACKGROUND: To treat advanced @entity712 due to @entity1000 , surgical ventricular restoration with mitral reconstruction was conducted and evaluated. METHODS: In 95 @entity1 (81 @entity1 , mean age: 54 years), New York Heart Association class III/IV was 44/51, and 33 @entity1 (36%) were inotropic dependent preoperatively. @entity339 (>or=2+) was noted in all @entity1 . All @entity1 underwent left ventriculoplasty (septal anterior ventricular exclusion in 38, partial left ventriculectomy in 57) and mitral reconstruction (repair 53, replacement 42). Fifty-two @entity1 (55%) had concomitant tricuspid repair. Intra-aortic balloon pumping and left ventricular assist device was used in 24 @entity1 and two @entity1 , respectively. RESULTS: Hospital mortality was 11.6% (11 of 95), with 6.6% (5 of 76) in elective and 31.6% (6 of 19) in emergency operations. The ejection fraction and cardiac index increased from 22.3+/-6.3% to 27.2+/-8.0% and from 2.3+/-0.5 ml/m2/min to 2.8+/-0.5 ml/m2/min, respectively (p<0.001). The endodiastolic volume index, endosystolic volume index and diastolic dimension decreased from 232.9+/-56.1 ml/m2 to 160.0+/-49.8 ml/m2, from 178.9+/-46.7 ml/m2 to 113.8+/-44.7 ml/m2 and from 82.0+/-9.0 mm to 68.9+/-11.6 mm, respectively (p<0.001). Late @entity204 occurred in 27 @entity1 with 22 @entity204 . The mean NYHA class was 1.7 among the survivors. One-, 3- and 5-year survival rates were 72.8%, 61.4% and 50.5%, respectively. In the 62 @entity1 who were non-inotropic dependent preoperatively, 1-, 3-, and 5-year survival rates (81.8%, 73.7% and 62.9%) were significantly better than the inotropic-dependent group (55.3%, 37.3% and 28.0%). @entity1 with mitral annuloplasty showed a significantly higher 5-year survival rate than @entity1 with mitral valve replacement (59.6% vs 43.6%) in univariate analysis. By application of the exclusion site selection method, the two different ventriculoplasty procedures did not show significant difference in survival rates. Multivariate analysis showed that preoperative inotropes and old age were significant predictors for postoperative mortality. CONCLUSION: The selected ventriculoplasty in combination with mitral annuloplasty is a useful option for @entity1 with an extremely dilated @entity5707 in @entity1000 . Surgery should be considered before inotropic dependency occurs when prior medical treatment has failed.
