Early Results of Left Ventricular Reconstruction for Ischemic Cardiomyopathy with Severe Left Ventricular Dysfunction / 日本心臓血管外科学会雑誌

Left ventricular reconstruction methods (LVR) consisting of the Dor procedure or septal anterior ventricular exclusion (SAVE) have been advocated for left ventricular dysfunction due to ischemic cardiomyopathy (ICM). This study reports early results achieved with LVR in patients with ICM. Between April 2001 and August 2004, 9 patients with ICM underwent LVR and coronary artery bypass grafting (CABG). Their age was 62±11 years, and 7 were men. The Dor procedure was performed in 8 patients and 1 patient underwent SAVE. CABG was performed in all patients. Two patients with grade 3 mitral regurgitation (MR) preoperatively had mitral valve annuloplasty (MAP). The mean left ventricular ejection fraction (LVEF) improved from 31.6±7.2% to 47.8±9.4%. The mean left ventricular end diastolic volume index (LVEDVI) decreased from 166.7±50.4ml/m² to 102.6±23.0ml/m². The mean left ventricular end systolic volume index (LVESVI) decreased from 114.4±34.7ml/m² to 52.4±16.6ml/m². The mean coaptation depth decreased from 9.3±3.1mm to 4.5±1.4mm. The mean MR, with or without MAP, improved from grade 1.7±1.1 to grade 0.2±0.4. There were no hospital deaths. Seven of 9 patients were categorized as New York Heart Association functional class I at discharge. We conclude that LVR is an effective treatment for ICM with severe left ventricular dysfunction.

Coronary Artery Bypass Grafting Using in Situ Bilateral Internal Thoracic Arteries / 日本心臓血管外科学会雑誌

Coronary artery bypass grafting (CABG) using <i>in situ</i> skeletonized arterial conduits with an off-pump technique is a high quality and minimally invasive procedure. The internal thoracic artery (ITA) is the most reliable conduit as grafting the left anterior descending artery and circumflex arteries with bilateral ITAs leads to better long-term patient outcomes. In this study, we demonstrated the feasibility and usefulness of off-pump coronary artery bypass grafting surgery using bilateral ITAs. A total of 217 consecutive CABG cases using skeletonized ITA grafts were studied and they were divided into 2 groups are using unilateral ITA (UITA, <i>n</i>=104) and the other using bilateral ITA (BITA, <i>n</i>=113). OPCAB was completed in 94% (98/104) in the UITA group and in 99% (112/113) in the BITA group. The mean number of distal anastomoses per patient was 3.02 in the UITA group and 3.63 in the BITA group. The ITAs were used <i>in situ</i> in 100% (104 ITAs) in the UITA group and in 96% (217 ITAs) in the BITA group. One patient in the UITA group suffered from mediastinitis and one patient in the BITA group died due to intestinal ischemia 3 days after operation. Postoperative angiography was performed before discharge in 101 patients in UITA and 99 in BITA. The patency rate was 98.7% in the UITA group and 99.4% in the BITA group. OPCAB with bilateral skeltonized ITAs is a feasible and safe technique with excellent early clinical results and graft patency. OPCAB using <i>in situ</i> skeletonized artery conduits can become a standard surgical treatment for ischemic heart disease.