[Combined surgery for ischemic cardiomyopathy].

The results of combined surgery for ischemic cardiomyopathy were reviewed focusing on the selection of operative procedures. Left ventricular volume reduction was performed in 33 patients. Hospital mortality was 17% in Dor procedure (n=24), 20% in Batista operation (n=5) and 0% in over-lapping method (n=4). Procedures should be selected according to left ventricular wall area to be excluded. Mitral valve plasty was performed in 50 patients, and early and late results of our original "papillary muscle sandwich plasty" (n=27) was superior to those of other conventional procedures (n=23). In "sandwich plasty", the papillary muscle heads of the anterior and the posterior mitral valve leaflets are approximated using tefron-pledgeted 3-0 ticron suture at the anterolateral and posteromedian commissural portions, respectively. In conclusion, active combined surgery is necessary for the treatment of ischemic cardiomyopathy.

Hemodynamic effects of dexmedetomidine in patients after cardiac surgery.

AIM: Dexmedetomidine hydrochloride (Prece-dex(R)) is a potent and highly selective central a2-adrenoreceptor agonist. Dexmedetomidine has recently been approved as a new sedative drug, however, its hemodynamic effects on patients just after cardiac surgery has not been established. METHODS: Nineteen patients (14 males and 5 females) who underwent elective cardiovascular surgery were included in this study. The mean age of the patients was 65 years. Coronary artery bypass grafting was performed in 8 patients, aortic valve surgery in 5, mitral valve plus radiofrequency Maze surgery in 3, graft replacement of the ascending aorta in 2 and double valve replacement in 1. After surgery, dexmedetomidine was continuously infused for 3 h in total at a rate of 0.8 mg/kg/h for the initial 1 h and followed by 0.4 mg/kg/h. RESULTS: All patients were well sedated during dexmedetomidine infusion. Dexmedetomidine infusion induced a decrease in systemic blood pressure and systemic vascular resistance index. Heart rate, stroke index, central venous pressure, pulmonary artery pressure and pulmonary artery resistance index remained unchanged. Mixed venous oxygen saturation significantly decreased and arterio-venous O2 content difference increased after the beginning of dexmedetomidine infusion. CONCLUSIONS: Continuous dexmedetomidine infusion did not influence the hemodynamic condition except for the vaso-dilating effect, thus dexmedetomidine was considered to be a viable sedative drug after cardiac surgery.