JTCS Sign the Guestbook
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Menicanti, L.
Right arrow Articles by Santo, D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Menicanti, L.
Right arrow Articles by Santo, D.
Related Collections
Right arrow Valve disease

J Thorac Cardiovasc Surg 2002;123:1041-1050
© 2002 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Ischemic mitral regurgitation: Intraventricular papillary muscle imbrication without mitral ring during left ventricular restoration

L. Menicanti, MDa, M. Di Donato, MDb, A. Frigiola, MDa, G. Buckberg, MDc, C. Santambrogio, MDa, M. Ranucci, MDa, D. Santo, MDa The RESTORE Group

From the Departments of Cardiac Surgery and Anesthesiology, Istituto Policlinico San Donato, San Donato Milanese, Milan, Italy,a the Department of Critical Care Medicine, University of Florence, Florence, Italy,b and the Department of Cardiac Surgery, University of California at Los Angeles School of Medicine, Los Angeles, Calif.c

Received for publication April 5, 2001. Revisions requested May 11, 2001; revisions received Sept 25, 2001. Accepted for publication Oct 31, 2001. Address for reprints: Lorenzo Menicanti, MD, Istituto Policlinico San Donato, Via Morandi 30, San Donato Milanese, Milan, Italy (E-mail menicanti{at}libero.it).

Objectives: Functional mitral regurgitation in ischemic cardiomyopathy carries a poor prognosis, and its surgical management remains problematic and controversial. The aim of this study was to report the results of our surgical approach to patients who have had myocardial infarctions and have ventricular dilatation, mitral regurgitation, reduced pump function, pulmonary hypertension and coronary artery disease. This surgical approach consists of endoventricular mitral repair without prosthetic ring, ventricular reconstruction with or without patch, and coronary artery bypass grafting.
Patients: Forty-six patients (aged 64 ± 10 years) with previous anterior transmural myocardial infarction and mitral regurgitation comprised the study group. Indication for surgery was heart failure in 93% of cases; 25 patients were in New York Heart Association functional class IV and 17 were in class III. Mitral regurgitation was moderate to severe in 32 cases (69%).
Results: All patients underwent coronary artery bypass grafting, with a mean of 3.2 ± 1.3 grafts. Associated aortic valve replacement was performed in 4 cases. Global operative mortality rate was 15.2%. End-diastolic and end-systolic volumes significantly decreased after surgery (from 140 ± 40 to 98 ± 36 mL/m2 and from 98 ± 32 to 63 ± 22 mL/m2, respectively, P = .001). Systolic pulmonary pressure decreased significantly (from 55 ± 13 to 43 ± 16 mm Hg, P = .001). Ejection fraction did not change significantly. Postoperative mitral regurgitation was absent or minimal in 84% of cases; 1 patient had severe mitral regurgitation necessitating valve replacement. New York Heart Association functional class significantly improved. The mean preoperative functional class was 3.4 ± 0.6 (median 3, range 2-4); after the operation, this decreased to 1.9 ± 0.7 (median 2, range 1-3, P < .001). Cumulative survival at a 30-month follow-up was 63%.
Conclusions: Our aggressive, combined surgical approach is aimed at correcting the three components of ischemic cardiomyopathy: relieving ischemia, reducing left ventricular wall tension by decreasing left ventricular volumes, and reducing volume overload and pulmonary hypertension by repairing the mitral valve. Despite a relatively high perioperative mortality rate, surviving patients benefitted from the operation, with improved clinical functional class and thus quality of life.




This article has been cited by other articles:


Home page
 Eur. J. Cardiothorac. Surg.Home page
P. Klein, J. J. Bax, L. J. Shaw, H. H.H. Feringa, M. I.M. Versteegh, R. A.E. Dion, and R. J.M. Klautz
Early and late outcome of left ventricular reconstruction surgery in ischemic heart disease
Eur. J. Cardiothorac. Surg., December 1, 2008; 34(6): 1149 - 1157.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
K. Takeda, G. Matsumiya, H. Matsue, S. Hamada, M. Sakaki, T. Sakaguchi, T. Fujita, and Y. Sawa
Use of quantitative analysis of remote myocardial fibrosis with delayed-enhancement magnetic resonance imaging to predict outcomes after surgical ventricular restoration for ischemic cardiomyopathy
J. Thorac. Cardiovasc. Surg., December 1, 2008; 136(6): 1514 - 1521.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. B. Prucz, E. S. Weiss, N. D. Patel, L. U. Nwakanma, A. S. Shah, and J. V. Conte
The Impact of Surgical Ventricular Restoration on Mitral Valve Regurgitation
Ann. Thorac. Surg., September 1, 2008; 86(3): 726 - 734.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. B. Prucz, E. S. Weiss, N. D. Patel, L. U. Nwakanma, W. A. Baumgartner, and J. V. Conte
Coronary Artery Bypass Grafting With or Without Surgical Ventricular Restoration: A Comparison
Ann. Thorac. Surg., September 1, 2008; 86(3): 806 - 814.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
S. Ishikawa, K. Ueda, A. Kawasaki, K. Neya, and H. Suzuki
Papillary muscle sandwich plasty for ischemic mitral regurgitation: A new simple technique.
J. Thorac. Cardiovasc. Surg., June 1, 2008; 135(6): 1384 - 1386.
[Full Text] [PDF]

Home page
 ICVTSHome page
K.-u Fumimoto, T. Fukui, T. Shimokawa, and S. Takanashi
Papillary muscle realignment and mitral annuloplasty in patients with severe ischemic mitral regurgitation and dilated heart
Interactive CardioVascular and Thoracic Surgery, June 1, 2008; 7(3): 368 - 371.
[Abstract] [Full Text] [PDF]

Home page
 Eur J EchocardiogrHome page
E. Agricola, M. Oppizzi, M. Pisani, A. Meris, F. Maisano, and A. Margonato
Ischemic mitral regurgitation: mechanisms and echocardiographic classification
Eur J Echocardiogr, March 1, 2008; 9(2): 207 - 221.
[Abstract] [Full Text] [PDF]

Home page
 Card Surg AdultHome page
W. Y. Szeto, R. C. Gorman, J. H. Gorman III, and M. A. Acker
Ischemic Mitral Regurgitation
Card. Surg. Adult, January 1, 2008; 3(2008): 785 - 802.
[Full Text]

Home page
 Card Surg AdultHome page
J. I. Fann, N. B. Ingels Jr., and D. C. Miller
Pathophysiology of Mitral Valve Disease
Card. Surg. Adult, January 1, 2008; 3(2008): 973 - 1012.
[Full Text]

Home page
 Eur J EchocardiogrHome page
P. Lancellotti, E. Donal, B. Cosyns, G. Van Camp, J.-L. Monin, E. Brochet, A. Berrebi, P. Pibarot, C. Chauvel, C. Hassager, et al.
Effects of surgery on ischaemic mitral regurgitation: a prospective multicentre registry (SIMRAM registry)
Eur J Echocardiogr, January 1, 2008; 9(1): 26 - 30.
[Abstract] [Full Text] [PDF]

Home page
 MMCTSHome page
D. Lindblom, A. Albage, and U. Sartipy
Surgery for ventricular tachycardia in patients undergoing surgical ventricular restoration
MMCTS, December 17, 2007; 2007(1217): 2816.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
A. Rama, L. Praschker, E. Barreda, and I. Gandjbakhch
Papillary Muscle Approximation for Functional Ischemic Mitral Regurgitation
Ann. Thorac. Surg., December 1, 2007; 84(6): 2130 - 2131.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. Di Donato, S. Castelvecchio, J. Brankovic, C. Santambrogio, V. Montericcio, and L. Menicanti
Effectiveness of surgical ventricular restoration in patients with dilated ischemic cardiomyopathy and unrepaired mild mitral regurgitation.
J. Thorac. Cardiovasc. Surg., December 1, 2007; 134(6): 1548 - 1553.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
L. Menicanti, S. Castelvecchio, M. Ranucci, A. Frigiola, C. Santambrogio, C. de Vincentiis, J. Brankovic, and M. Di Donato
Surgical therapy for ischemic heart failure: Single-center experience with surgical anterior ventricular restoration
J. Thorac. Cardiovasc. Surg., August 1, 2007; 134(2): 433 - 441.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
U. Sartipy, A. Albage, P. T. Larsson, P. Insulander, and D. Lindblom
Changes in B-type natriuretic peptides after surgical ventricular restoration
Eur. J. Cardiothorac. Surg., May 1, 2007; 31(5): 922 - 928.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
U. Sartipy, A. Albage, E. Mattsson, and D. Lindblom
Edge-to-Edge Mitral Repair Without Annuloplasty in Combination With Surgical Ventricular Restoration
Ann. Thorac. Surg., April 1, 2007; 83(4): 1303 - 1309.
[Abstract] [Full Text] [PDF]

Home page
 ICVTSHome page
T. Ueno, R. Sakata, M. Ueno, and T. Ueno
Papillary muscle elevation: an alternative subvalvular procedure for selective relocation of displaced posterior papillary muscle in posteroinferior infarction
Interactive CardioVascular and Thoracic Surgery, February 1, 2007; 6(1): 9 - 11.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
U. Sartipy, A. Albage, and D. Lindblom
Risk factors for mortality and hospital re-admission after surgical ventricular restoration
Eur. J. Cardiothorac. Surg., November 1, 2006; 30(5): 762 - 769.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. Ueno, R. Sakata, Y. Iguro, T. Nagata, Y. Otsuji, and C. Tei
New Surgical Approach to Reduce Tethering in Ischemic Mitral Regurgitation by Relocation of Separate Heads of the Posterior Papillary Muscle
Ann. Thorac. Surg., June 1, 2006; 81(6): 2324 - 2325.
[Abstract] [Full Text] [PDF]

Home page
 ICVTSHome page
M. H. Mandegar, F. Roshanali, M. A. Yousefnia, and M. Marzban
Papillary muscle approximation combined with ventriculoplasty in patients with ischemic cardiomyopathy and functional mitral regurgitation: effects on mitral valve and LV shape
Interactive CardioVascular and Thoracic Surgery, April 1, 2006; 5(2): 81 - 84.
[Abstract] [Full Text] [PDF]

Home page
 ICVTSHome page
F. Nomura, T. Isomura, T. Horii, H. Irie, J. Hoshino, H. Makinae, and H. Suma
Efficacy of left ventricular restoration with mitral valve surgery for endstage ischemic cardiomyopathy
Interactive CardioVascular and Thoracic Surgery, April 1, 2006; 5(2): 179 - 182.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
M. Di Donato, P. Dabic, S. Castelvecchio, C. Santambrogio, J. Brankovic, L. Collarini, T. Joussef, A. Frigiola, G. Buckberg, L. Menicanti, et al.
Left ventricular geometry in normal and post-anterior myocardial infarction patients: sphericity index and 'new' conicity index comparisons
Eur. J. Cardiothorac. Surg., April 1, 2006; 29(Suppl_1): S225 - S230.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
L. A. Bockeria, A. J. Gorodkov, A. V. Dorofeev, M. D. Alshibaya, and the RESTORE Group
Left ventricular geometry reconstruction in ischemic cardiomyopathy patients with predominantly hypokinetic left ventricle
Eur. J. Cardiothorac. Surg., April 1, 2006; 29(Suppl_1): S251 - S258.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. A. Borger, A. Alam, P. M. Murphy, T. Doenst, and T. E. David
Chronic Ischemic Mitral Regurgitation: Repair, Replace or Rethink?
Ann. Thorac. Surg., March 1, 2006; 81(3): 1153 - 1161.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
Y. K. Mishra, S. Mittal, P. Jaguri, and N. Trehan
Coapsys Mitral Annuloplasty for Chronic Functional Ischemic Mitral Regurgitation: 1-Year Results
Ann. Thorac. Surg., January 1, 2006; 81(1): 42 - 46.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
G. Buckberg, L. Menicanti, S. De Oliveira, C. Athanasuleas, and the RESTORE Team
Restoring an elliptical chamber during rebuilding a wrap around anterior infarction
Eur. J. Cardiothorac. Surg., November 1, 2005; 28(5): 772 - 774.
[Abstract] [Full Text] [PDF]

Home page
 ICVTSHome page
G. Buckberg, L. Menicanti, S. De Oliveira, T. Isomura, and and the RESTORE team
Restoring papillary muscle dimensions during restoration in dilated hearts
Interactive CardioVascular and Thoracic Surgery, October 1, 2005; 4(5): 475 - 477.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Physiol. Heart Circ. Physiol.Home page
H.-Y. Yu, M.-Y. Su, Y.-S. Chen, F.-Y. Lin, and W.-Y. I. Tseng
Mitral tetrahedron as a geometrical surrogate for chronic ischemic mitral regurgitation
Am J Physiol Heart Circ Physiol, September 1, 2005; 289(3): H1218 - H1225.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
S. Geidel, M. Lass, C. Schneider, G. Groth, S. Boczor, K.-H. Kuck, and J. Ostermeyer
Downsizing of the mitral valve and coronary revascularization in severe ischemic mitral regurgitation results in reverse left ventricular and left atrial remodeling
Eur. J. Cardiothorac. Surg., June 1, 2005; 27(6): 1011 - 1016.
[Abstract] [Full Text] [PDF]

Home page
 MMCTSHome page
L. Menicanti and M. Di Donato
Left ventricular aneurysm/reshaping techniques
MMCTS, April 25, 2005; 2005(0425): 596.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
M. R. Mehra and B. P. Griffith
Is mitral regurgitation a viable treatment target in heart failure?: The plot just thickened
J. Am. Coll. Cardiol., February 1, 2005; 45(3): 388 - 390.
[Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
L. Menicanti and M. Di Donato
Surgical left ventricle reconstruction, pathophysiologic insights, results and expectation from the STICH trial
Eur. J. Cardiothorac. Surg., December 1, 2004; 26(Suppl_1): S42 - S47.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
H.-Y. Yu, M.-Y. Su, T.-Y. Liao, H.-H. Peng, F.-Y. Lin, and W.-Y. I. Tseng
Functional mitral regurgitation in chronic ischemic coronary artery disease: Analysis of geometric alterations of mitral apparatus with magnetic resonance imaging
J. Thorac. Cardiovasc. Surg., October 1, 2004; 128(4): 543 - 551.
[Abstract] [Full Text] [PDF]

Home page
 Eur J EchocardiogrHome page
R. A. Levine, E. Messas, N. S. Nathan, and L. G. Rudski
New understanding of ischemic mitral regurgitation: the marionette and its masters
Eur J Echocardiogr, October 1, 2004; 5(5): 313 - 317.
[Full Text] [PDF]

Home page
 Eur J EchocardiogrHome page
E. Agricola, M. Oppizzi, F. Maisano, M. De Bonis, A. F.L. Schinkel, L. Torracca, A. Margonato, G. Melisurgo, and O. Alfieri
Echocardiographic classification of chronic ischemic mitral regurgitation caused by restricted motion according to tethering pattern
Eur J Echocardiogr, October 1, 2004; 5(5): 326 - 334.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
M. Di Donato, A. Frigiola, M. Benhamouda, and L. Menicanti
Safety and Efficacy of Surgical Ventricular Restoration in Unstable Patients With Recent Anterior Myocardial Infarction
Circulation, September 14, 2004; 110(11_suppl_1): II-169 - II-173.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. D. Diodato, M. R. Moon, M. K. Pasque, H. B. Barner, N. Moazami, J. S. Lawton, M. S. Bailey, T. J. Guthrie, B. F. Meyers, and R. J. Damiano Jr
Repair of ischemic mitral regurgitation does not increase mortality or improve long-term survival in patients undergoing coronary artery revascularization: A propensity analysis
Ann. Thorac. Surg., September 1, 2004; 78(3): 794 - 799.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
E. H. Kincaid, R. D. Riley, M. H. Hines, J. W. Hammon, and N. D. Kon
Anterior leaflet augmentation for ischemic mitral regurgitation
Ann. Thorac. Surg., August 1, 2004; 78(2): 564 - 568.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. Inoue, P. M. McCarthy, Z. B. Popovic, K. Doi, S. Schenk, H. Nemeh, Y. Ootaki, M. W. Kopcak Jr, R. Dessoffy, J. D. Thomas, et al.
The Coapsys device to treat functional mitral regurgitation: In vivo long-term canine study
J. Thorac. Cardiovasc. Surg., April 1, 2004; 127(4): 1068 - 1077.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
Y. Matsui, Y. Fukada, Y. Naito, and S. Sasaki
Integrated overlapping ventriculoplasty combined with papillary muscle plication for severely dilated heart failure
J. Thorac. Cardiovasc. Surg., April 1, 2004; 127(4): 1221 - 1223.
[Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
T. S. Maxey, T. B. Reece, P. I. Ellman, P. D. Butler, J. A. Kern, C. G. Tribble, and I. L. Kron
Coronary artery bypass with ventricular restoration is superior to coronary artery bypass alone in patients with ischemic cardiomyopathy
J. Thorac. Cardiovasc. Surg., February 1, 2004; 127(2): 428 - 434.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
R. A. Levine and J. Hung
Ischemic mitral regurgitation, the dynamic lesion: clues to the cure
J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1929 - 1932.
[Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
T. Isomura, H. Suma, A. Yamaguchi, T. Kobashi, and A. Yuda
Left ventricular restoration for ischemic cardiomyopathy - comparison of presence and absence of mitral valve procedure
Eur. J. Cardiothorac. Surg., April 1, 2003; 23(4): 614 - 619.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
L. Menicanti and M. Di Donato
The Dor procedure: What has changed after fifteen years of clinical practice?
J. Thorac. Cardiovasc. Surg., November 1, 2002; 124(5): 886 - 890.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2002 by The American Association for Thoracic Surgery.