NEW OPPORTUNITIES OF LIFE PROLONGATION IN PATIENTS WITH END STAGE DILATED CARDIOMYOPATHY

Abstract

In the present study we summarize our fist experience in multi stage Surgical reconstruction of left ventricle, heart valves and coronary arteries in patients with the end stage dilated cardiomyopathy. 21 patients (aged 24 to 63) had been operated on during last 3 years. Five patients were presented with idiopathic cardiomyopathy and 13 – with ischemic cardiomyopathy. All patients were in NYHA class lll and lV. Cardio-thoracic ratio was more then 60% in all cases. Mean LV diastolic volume was 283,6±93,7 ml, mean LV diastolic diameter - 76,8±9,1 mm, ejection fraction 25,7±5,8%. Mean LV and diastolic pressure ranged 15-62 mm Hg. Coronary stenoses (1 to 3 arteries) were presented in all patients with ischemic cardiomyopathy. Mitral regurgitation (grade II-III ) was found in all patients and associated with tricuspid insufficiency. Five patients suffered from atrial fibrillation. Three types of procedure were performed including Batista procedure (1), mitral and/or mitral-tricuspid annuloplasty (5), Dor procedure with mitral annuloplasty and CABG where necessary (13). Four patients died postoperatively. All survivors demonstrated significant clinical improvement (2 shifted to NYHA class III and 9 – to NYHA class II) with reduction of cardio-thoracic ratio and increasing of ejection to 37,5-4,1%