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New Subvalvular Procedure Combined with Mitral Valve Replacement for Intractable Heart Failure


  • #AC/VAL 02-O-7
  • Adult Cardiac Surgery/Valves. SESSION-2
  • Oral

New Subvalvular Procedure Combined with Mitral Valve Replacement for Intractable Heart Failure

Yoshiro Matsui, Yasushige Shingu, Satoru Wakasa, Tomonori Ooka, Tsuyoshi Tachibana, Suguru Kubota

The Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan

Date, time and location: 2018.05.26 13:30, Congress Hall, 2F–B

Abstract

Objective: We present our new concept of surgical approach for intractable heart failure named papillary muscles tugging approximation (PMTA) combined with mitral valve replacement (MVR) mechanical valve for non-ischemic dilated cardiomyopathy (NIDCM) and severely deteriorated ischemic cardiomyopathy (ICM) not indicated or refusal of transplantation.

Methods: From Dec　2015-Dec 2017, we performed 14 PMTA with MVR for 8 DCM (3 catecholamine (CA) dependent) and 6 ICM cases. PMTA is our original new subvalvular procedure in which papillary muscle approximation with suspension to both commissural sites and mitral anterior annulus after resection of mitral anterior leaflet. Preoperative data were as follows; age 63±8 years old, BNP 1002±624 pg/m, LVDd 71±9mm, LVEF 21±5% in total.

Results: We experienced no operative death. The longest follow-up was 2years. In this case, preoperative EF and BNP was 12% and 882pg/ml with CA, and after 2 years 54% and 82pg/ml respectively. In DCM cases, LVDd, EF, forward SV and BNP improved from 68±10mm, 22±5%, 31±10ml, 783±376pg/ml to 63±9mm, 37±8%, 54±16ml. 126±46pg/ml respectively in the latest follow-up. In ICM cases, LVDd, EF, forward SV, and BNP improved from 75±7mm, 20±4%, 42±5ml, 1189±852pg/ml to 71±6mm, 23±3%, 54±10ml, 191±114pg/ml respectively in the latest follow-up.

Conclusion: In recent guideline, MVR is recommended for ICM cases. However there was no superior data to MVPlasty in terms of long-term survival. From our experiences with volume reduction surgery, it might cause postoperative LOS in case of severely deteriorated heart. Other operative option such as PMTA may have a role in such cases.

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