Nontransplant Cardiac Surgery for End-Stage Cardiomyopathy

Suma, Hisayoshi; Isomura, Tadashi; Horii, Taiko; Satô, Tôru; Kikuchi, Norio; K, Iwahashi; Hosokawa, Joji

doi:10.1067/mtc.2000.106520

Cited by 95 publications

(65 citation statements)

References 26 publications

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“…1,2 In Japan, this procedure was first used in December, 1996, 6 but has had limited success in some institutes. 3,4,6 However, PLV is an acceptably safe and effective treatment for end-stage cardiomyopathy with proper choice of patients. 6 We previously reported that severe inflammatory cell infiltration might serve as a predictor of poor outcome in patients with DCM, 18,19 and the present study, which included a larger number of patients, demonstrated that the infiltrating inflammatory cell count was significantly greater in patients who died of left ventricular dysfunction after PLV than in patients who survived.…”

Section: Discussionmentioning

confidence: 99%

Myocardial Inflammatory Cell Infiltrates in Cases of Dilated Cardiomyopathy as a Determinant of Outcome Following Partial Left Ventriculectomy.

et al. 2001

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eart transplantation has been used to treat dilated cardiomyopathy (DCM) in patients in whom medical therapy or a left ventricular assist device has failed. However, there are a limited number of hearts available for transplantation, and many patients die while awaiting transplantation. Recently, partial left ventriculectomy (PLV; the Batista procedure) 1-6 has received attention as an alternative or bridging treatment for severe cardiomyopathies. In this operation, the surgeon partially resects the left ventricle in an attempt to decrease left ventricular wall tension by reducing chamber volume. Therefore it is necessary to establish the indications for this procedure and to determine the prognosis following this surgery.Immunologic abnormalities, viral infections, and genetic predisposition are possible factors involved in the development of myocardial injury in DCM. 7 The presence of inflammatory cell infiltrates [8][9][10][11] and viral genomes [12][13][14][15] 16,17 It is therefore quite important to determine the role of inflammatory cell infiltrates or active myocarditis in the development of DCM.The histopathologic features of myocardial injury and the severity of cardiomyopathy are considered to be factors determining the prognosis following PLV. We previously reported that severe inflammatory cell infiltration might serve as a predictor of poor outcome, 18,19 but we could not determine a significant correlation between any histopathologic findings and the early prognosis of patients with DCM following PLV, because the number of patients was too small.The purpose of present study was to determine the involvement of active myocarditis in DCM using histopathologic, immunohistochemical and virologic studies of myocardial specimens obtained by PLV. In addition, this study aimed to determine the relationship between the histopathologic findings and the early prognosis of patients with DCM following PLV using more histopathologic factors in a larger number of cases compared with our previous study. 18,19 Jpn Circ J 2001; 65: 797 -802 (Received October 27, 2000; revised manuscript received May 28, 2001; accepted June 11, 2001 Yasuhiro Horii, MD*; Tadashi Isomura, MD*; Hisayoshi Suma, MD* Partial left ventriculectomy (PLV) can be used to treat refractory congestive heart failure caused by dilated cardiomyopathy (DCM). In order to understand the relationship between the underlying myocardial injury and early clinical outcomes after PLV, histopathologic, immunohistochemical and virologic studies of the resected myocardium were performed. The posterolateral left ventricular walls from 27 patients with idiopathic DCM were examined. Cardiomyocyte diameter, degree of myocardial fibrosis, degree of cardiomyocyte degeneration, and degree of inflammatory cell infiltration were compared with mortality rates. Polymerase chain reaction was performed to detect enterovirus genome in the myocardium. Some patients had inflammatory cell infiltrates with focal accumulations of lymphocytes and macrophages, including both cytot...

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Section: Discussionmentioning

confidence: 99%

Myocardial Inflammatory Cell Infiltrates in Cases of Dilated Cardiomyopathy as a Determinant of Outcome Following Partial Left Ventriculectomy.

et al. 2001

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“…9 The current indications and efficacy of partial left ventriculectomy for advanced heart failure in patients with dilated cardiomyopathy are controversial. 9,10 Because the systemic ventricle was markedly dilated in the present patient, and the lateral segment had a myocardial perfusion defect, we considered that systolic function could be improved by reducing the volume of the systemic ventricle, particularly by removing the fibrous segment as in aneurysmectomy. Recent reports indicate that mitral valve surgery can rescue patients with heart failure who have a dilated and poorly contracting left ventricle accompanied by moderate to severe mitral regurgitation, 10 but we considered that mitral replacement would not provide relief for this patient because he had already undergone that treatment 9 years before.…”

Section: Discussionmentioning

confidence: 99%

Congenitally Corrected Transposition of the Great Arteries Treated by Partial Systemic Ventriculectomy.

Kobashi

Suwa

Nakamura

et al. 2003

Circ J

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42-year-old man was admitted to hospital with worsening dyspnea. At the age of 18, he underwent annuloplasty of the systemic AV valve for severe valvular regurgitation related to CCTGA at another hospital and did not have any problems on follow-up until age 33 when he visited hospital with paroxysmal nocturnal dyspnea. Because the systemic AV valve regurgitation had recurred to a severe degree and systemic ventricular contraction had decreased, he underwent systemic AV valve replacement and annuloplasty of the pulmonary AV valve. At age 39, atrial fibrillation with a rapid heart rate developed and could not be controlled with medications, so the His-bundle was cryoablated to block AV conduction and a permanent rate-adaptive pacemaker inserted intravenously. Although he was controlled in all pacemaker rhythm without tachycardia, his systemic ventricular function decreased and he was in New York Heart Association (NYHA) functional class 4 even after receiving digitalis, diuretics, angiotensin-converting enzyme inhibitor (ACEI) and other oral inotropic agents.His height was 185 cm and body weight was 75 kg. His blood pressure was 116/60 mmHg and the pulse rate was 60 beats/min and regular. Auscultation showed no significant murmur. Electrocardiograms revealed all pacemaker rhythm (VVI). Chest X-rays showed a cardiothoracic ratio of 58% and systemic atrial and ventricular enlargement. Echocardiography revealed enlargement of the systemic atrium and ventricle, and reduction of the systemic ventricular systolic function (the left atrial dimension was 4.7 cm, the end-diastolic dimension of the systemic ventricle was 8.6 cm and the fractional shortening was 14%) ( Table 1, Fig 1). Pulmonary wedge pressure and right-side pressures were elevated ( Table 2). The systemic ventriculogram showed diffused hypokinesis, but myocardial perfusion imaging using technetium-99m tetrofosmin indicated a severe perfusion defect in the lateral wall and the apex at rest.Because his symptoms could not be relieved by medical treatment, he was transferred to Shonan Kamakura General Hospital to undergo partial systemic ventriculectomy in February 1998. Under cardiopulmonary bypass (CPB) with heart beating and without aortic cross-clamping, the systemic ventricle was incised laterally from the apex to the base. There was neither mitral apparatus nor recognizable papillary muscle because of the previous valve replacement. Much of the anterolateral wall that was thin and akinetic on intraoperative palpation, and which corresponded to the defect on perfusion imaging, was excised in a tear-drop shape (7 cm wide and 12 cm long, 66 g in weight). Closure of the ventricle was done in 2 layers. The duration of CPB was 73 min and ventricular function recovered well without mechanical support. The resected myocardium had severe interstitial fibrosis (28.5%) and mild degeneration and hypertrophy of the myocardial cells.On echocardiography, the end-diastolic dimension of the systemic ventricle decreased to 5.7 cm, but the ejection fraction (EF) had not cha...

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“…Matsui et al [18] reported the usefulness of integrated overlapping ventriculoplasty combined with papillary muscle plication for severely dilated heart failure. Suma et al [16] have showed that an intraoperative echographic evaluation is important for the purpose of proper site selection for ventricular reduction in end-stage cardiomyopathy. We performed an intraoperative echographic evaluation under the CPB in the present case, and confirmed that the contraction of the left ventricle was diffuse hypokinetic, especially severe hypokinetic in the anteroseptal wall, and that localization of changes in the LV wall thickness could not be observed.…”

Section: Discussionmentioning

confidence: 99%

Modified Batista Procedure for Idiopathic Dilated Cardiomyopathy: Report of a Case

Morimoto¹,

Kuroda²,

Ono³

et al. 2017

WJCS

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The surgical indications for dilated cardiomyopathy (DCM) remain controversial, not including cardiac transplantation and mechanical circulatory support. We describe a case of idiopathic DCM that underwent successful surgical treatment using a modified left ventriculectomy, modification of the Batista procedure. The patient was a 63-year-old man who suffered from heart failure, New York Heart Association (NYHA) Class IV. Heart failure was derived from idiopathic DCM with a severely compromised left ventricular function complicated by left ventricular thrombosis. He underwent successful surgical treatment, specifically partial left ventriculectomy combined with the papillary muscle approximation, and the postoperative course was uneventful. He has been well with NYHA Class I for 3 years after the operation without heart failure.

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Nontransplant Cardiac Surgery for End-Stage Cardiomyopathy

Cited by 95 publications

References 26 publications

Myocardial Inflammatory Cell Infiltrates in Cases of Dilated Cardiomyopathy as a Determinant of Outcome Following Partial Left Ventriculectomy.

Myocardial Inflammatory Cell Infiltrates in Cases of Dilated Cardiomyopathy as a Determinant of Outcome Following Partial Left Ventriculectomy.

Congenitally Corrected Transposition of the Great Arteries Treated by Partial Systemic Ventriculectomy.

Modified Batista Procedure for Idiopathic Dilated Cardiomyopathy: Report of a Case

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