XXXX : intraventricular papillary muscle imbrication without mitral ring during left ventricular restoration.

@entity1 @entity296 @entity339 @entity712 @entity63 @entity120 @entity2554 @entity453 @entity583 @entity1284
OBJECTIVES: Functional @entity339 in @entity296 carries a poor prognosis, and its surgical management remains problematic and controversial. The aim of this study was to report the results of our surgical approach to @entity1 who have had @entity583 and have @entity2554 , @entity339 , reduced pump function, @entity120 and @entity453 . This surgical approach consists of endoventricular mitral repair without prosthetic ring, ventricular reconstruction with or without patch, and coronary artery bypass grafting. @entity1 : Forty-six @entity1 (aged 64 +/- 10 years) with previous anterior transmural @entity583 and @entity339 comprised the study group. Indication for surgery was @entity712 in 93% of cases; 25 @entity1 were in New York Heart Association functional class IV and 17 were in class III. @entity339 was moderate to severe in 32 cases (69%). RESULTS: All @entity1 underwent coronary artery bypass grafting, with a mean of 3.2 +/- 1.3 grafts. Associated aortic valve replacement was performed in 4 cases. Global operative mortality rate was 15.2%. End-diastolic and end-systolic volumes significantly decreased after surgery (from 140 +/- 40 to 98 +/- 36 mL/m(2) and from 98 +/- 32 to 63 +/- 22 mL/m(2), respectively, P =.001). Systolic pulmonary pressure decreased significantly (from 55 +/- 13 to 43 +/- 16 mm Hg, P =.001). Ejection fraction did not change significantly. Postoperative @entity339 was absent or minimal in 84% of cases; 1 @entity1 had severe @entity339 necessitating valve replacement. New York Heart Association functional class significantly improved. The mean preoperative functional class was 3.4 +/- 0.6 (median 3, range 2-4); after the operation, this decreased to 1.9 +/- 0.7 (median 2, range 1-3, P <.001). Cumulative survival at a 30-month follow-up was 63%. CONCLUSIONS: Our aggressive, combined surgical approach is aimed at correcting the three components of @entity296 : relieving @entity63 , reducing left ventricular wall tension by decreasing left ventricular volumes, and reducing @entity1284 and @entity120 by repairing the mitral valve. Despite a relatively high perioperative mortality rate, surviving @entity1 benefitted from the operation, with improved clinical functional class and thus quality of life.
