[Surgical ventricular restoration for functional mitral regurgitation].

BACKGROUND: This study evaluated the effectiveness and limitations of the surgical ventricular restoration(SVR)procedure in patients with functional mitral regurgitation(FMR)due to severe leaflet tethering. METHODS: From 2008 to 2012, FMR was treated in 39 patients by either mitral annuloplasty(MAP)alone( group M:n=17) or MAP combined with SVR( group S:n=22). Preoperatively, patients in group S had lower ejection fraction( EF), larger left ventricle, and more severe mitral regurgiation( MR) comparing to group M. RESULTS: The SVR performed in group S included posterior wall exclusion(Batista)in 10, septal-anteriorventricular exclusion in 8, overlapping ventriculoplasty in 2, and others in addition to papillary muscle approximation(PMA). Coronary revascularization was more common in the group M. Hospital mortality were 18% in group S and 0 in group M. There were no significant improvement on EF in both group, but left ventricular( LV) dimensions decreased significantly in both groups. Also, MR grade decreased significantly in both groups. Leaflet tethering was improved significantly in group S. There were 5 and 1 late deaths in group S and M, respectively. CONCLUSION: SVR in addition to MAP yielded excellent reduction of leaflet tethering and MR in patients with severe LV dilatation. However, long-term outcomes were poor in those requiring SVR.

Off-pump coronary artery bypass grafting with skeletonized bilateral internal thoracic arteries in insulin-dependent diabetics.

BACKGROUND: We evaluated the effects of coronary artery bypass with off-pump skeletonized bilateral internal thoracic artery grafting in patients with insulin-dependent diabetes. METHODS: One hundred eighty-five consecutive patients with insulin-dependent diabetes who underwent isolated coronary artery bypass grafting with bilateral internal thoracic grafts were retrospectively compared according to surgical technique, ie, off-pump grafting with skeletonized internal thoracic artery (n = 162) or on-pump grafting with pedicled internal thoracic artery (n = 23). RESULTS: The on-pump group was younger (62.3 +/- 9.2 versus 69.9 +/- 8.5 years; p = 0.02) and had fewer distal anastomoses (3.5 +/- 1.0 versus 4.0 +/- 1.1; p = 0.02) than the off-pump group. No 30-day mortality occurred in either group. The incidence of deep sternal infection was significantly lower in the off-pump group than in the on-pump group (0.6% versus 13.0%; p = 0.01). The early angiographic results did not differ between the two groups. The median duration of follow-up was 3.4 years (range, 0.1 to 9.9 years). Rates of survival, freedom from cardiac mortality, and freedom from cardiac-related events (including cardiac-related death, myocardial infarction, percutaneous coronary intervention, repeat coronary artery bypass grafting, and congestive heart failure) did not differ between the two groups. Dialysis, peripheral vascular disease, ejection fraction less than 0.40, and age were independent risk factors of late death. CONCLUSIONS: Overall, our results support the surgical management of coronary artery bypass grafting in insulin-dependent diabetics using off-pump skeletonized bilateral internal thoracic artery grafting.

Long-term results of bilateral internal thoracic artery grafting in dialysis patients.

BACKGROUND: We evaluated the perioperative and long-term results of bilateral internal thoracic artery grafting in dialysis patients. METHODS: One hundred one consecutive patients on chronic dialysis who underwent isolated coronary artery bypass grafting were retrospectively compared according to the surgical technique, bilateral internal thoracic artery (BITA) grafting (n = 76) or single internal thoracic artery (SITA) grafting (n = 25). RESULTS: Hospital mortality was 5.3% in the BITA group and 8.0% in the SITA group (p = not significant). The incidence of mediastinitis was not different (7.9% in the BITA group and 8.0% in the SITA group). The median duration of follow-up was 3.1 years (range, 0.1 to 10.9). Survival and freedom from cardiac mortality were not different between the two groups, but the BITA group had a trend toward better results. Freedom from cardiac events (including cardiac-related death, myocardial infarction, percutaneous coronary intervention, redo coronary artery bypass grafting, and congestive heart failure) was superior in the BITA group (p = 0.03). Calcification of the ascending aorta, peripheral vascular disease, insulin-dependent diabetes mellitis, and age were the independent risk factors of late death. CONCLUSIONS: Perioperative results of BITA grafting in dialysis patients were not different from the results of SITA grafting. However, the long-term results of BITA grafting in dialysis patients were better than the results of SITA grafting. Overall, our results support the continued use of BITA grafting in dialysis patients.