Nova abordagem cirúrgica para o tratamento de pacientes em insuficiência cardíaca refratária com miocardiopatia dilatada e insuficiência mitral secundária / A new surgical appoach for treating dilated cardiomyopathy with mitral regurgitation

ABSTRACT

OBJECTIVE: To evaluate the early outcome of mitral valve prostheses implantation and left ventricular remodeling in 23 patients with end-stage cardiomyopathy and secondary mitral regurgitation (NYHA class III and IV). METHODS: Mitral valvular prosthesis implantation with preservation of papillary muscles and chordae tendinae, and plasty of anteriun cuspid for remodeling of the left ventricle. RESULTS: The surgery was performed in 23 patients, preoperative ejection fraction (echocardiography) varied from 13 per cent to 44 per cent (median 30 per cent). In 13 patients associated procedures were performed myocardial revascularization (9), left ventricle plicature repair (3) and aortic prosthese implantation (1). Early deaths (2) occurred on the 4th PO day (cardiogenic shock) and on the 20th PO day (upper gastrointestinal bleeding), and a late death in the second month PO (ventricular arrhythmia). Improvement occurred in NYHA class in 82.6 per cent of the patients (P<0.0001), with a survival rate of 86.9 percent (mean of 8.9 months of follow-up). CONCLUSION: This technique offers a promising therapeutic alternative for the treatment of patients in refractory heartfailure with cardiomyopathy and secondary mitral regurgitation.