| Left ventricular reconstructive surgery in ischemic dilated cardiomyopathy complicated with cardiogenic shock. | |
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MedLine Citation:
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PMID: 18355522 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The feasibility of left ventricular restoration for patients with ischemic cardiomyopathy complicated with cardiogenic shock remains unclear. We report early and mid-term outcomes of surgical interventions including left ventricular restoration for patients with cardiogenic shock. METHODS: From April 2001 to June 2007, 10 patients with ischemic cardiomyopathy who developed cardiogenic shock underwent left ventricular restoration combined with mitral annuloplasty or coronary artery bypass grafting. All had been supported by a maximum dose of inotropic agents, 8 had required an intraaortic balloon pump, and 1 had required extracorporeal life support. Mean left ventricular end-diastolic and end-systolic volume indices were 142 +/- 33 mL/m(2) and 113 +/- 28 mL/m(2), respectively, and ejection fraction was 0.21 +/- 0.059. RESULTS: There was no mortality at 30 days. Five patients demonstrated significant recovery after the operation. Three patients simultaneously underwent left ventricular assist system (LVAS) implantation with left ventricular restoration because of preexisting severe end-organ failure, and 2 of them were subsequently weaned from LVAS, although 1 required reimplantation. The other 2 patients eventually underwent LVAS implantation in the early postoperative period. Two patients who required prolonged LVAS support underwent successful heart transplantation. Seven patients are alive at a mean follow-up of 1.9 years. Patients who required prolonged LVAS support had significantly longer duration of heart failure symptoms (p = 0.04) and higher mean pulmonary artery pressure (p = 0.02) preoperatively. CONCLUSIONS: Early combined surgical interventions including left ventricular restoration can be a choice of treatment even in patients with ischemic cardiomyopathy complicated with cardiogenic shock. Additional use of the LVAS followed by bridge to recovery or transplantation should be appropriately applied in these critically ill patients. |
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Authors:
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Koji Takeda; Goro Matsumiya; Hajime Matsue; Masayuki Sakaki; Taichi Sakaguchi; Tomoyuki Fujita; Yoshiki Sawa |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 85 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2008 Apr |
Date Detail:
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Created Date: 2008-03-21 Completed Date: 2008-04-16 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 1339-43 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Cardiomyopathy, Dilated / diagnosis, mortality, surgery* Cardiopulmonary Bypass / methods Cohort Studies Combined Modality Therapy Coronary Artery Bypass / methods* Female Follow-Up Studies Heart-Assist Devices Humans Male Middle Aged Mitral Valve / surgery* Probability Reconstructive Surgical Procedures / methods Retrospective Studies Risk Assessment Severity of Illness Index Shock, Cardiogenic / diagnosis, mortality* Stroke Volume Survival Analysis Treatment Outcome Ventricular Dysfunction, Left / diagnosis, mortality, surgery* Ventricular Remodeling / physiology |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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