Reconstruction of Mitral Valve & Left Ventricle for Endstage Cardiomyopathy,Hisayoshi Suma M.D. The Cardiovascular Institute Tokyo, Japan,大 家 好！,心脏血管研究所,我叫须磨久善,见到你们非常高兴！,HEART FAILURE,0,2,4,6,8,10,0.0,1.0,0.8,0.4,0.6,0.2,1950 - 1969 1970 - 1979 1980 - 1989 1990 - 1999,72,41,20,Probability of Survival,Years,LEVY et al, NEJM 2002,CRT,CARE-HF , NEJM 2005,ENDSTAGE CARDIOMYOPATHY,HEART TRANSPLANTATION,Heart Transplantation The last 10 years ,USA 20,000 Japan 52,Nontransplant Surgical Challenges for Endstage Cardiomyopathy,Ischemic CM,CABG MAP Ventriculoplasty (Dor, SAVE),Nonischemic CM,MAP Ventriculoplasty (PLV, SAVE),Triple V,Vessel Valve Ventricle,ISCHEMIC MR,Grigioni,Circulation,2001,MITRAL VALVE RECONSTRUCTION FOR ISCHEMIC MR,Survival,Months,n=4824 Ischemic24 Nonischemic All NYHA IIIIV & MR 4+,INTERMEDIATE-TERM OUTCOME OF MITRAL RECONSTRUCTION IN CARDIOMYOPATHY SF. Bolling, FD. Pagani, G. Michael Deeb, DS. Bach,JTCVS 1998;115,71%,Wu. et al.; J ACC 2005;45,MITRAL ANNUROPLASTY FOR DCM,MAP (+),MAP (-),Forward LVEF (%),LVEDVI (ml/m2),Preop. 438 mos.,Preop. 438 mos.,EF,EDVI,JTCVS 2008;135,Braun, Dion, et al. EJCTS 2005;27:847,MITRAL ANNULOPLASTY FOR IMR - Prediction of reverse remodeling -,Ann Thorac Surg 2006;82:1349-55,Left ventricle volume affects the result of mitral valve surgery for idiopathic dilated cardiomyopathy to treat congestive heart failure,Taiko Horii, Hisayoshi Suma, Tadashi Isomura, Fumikazu Nomura, Joji Hoshino,MITRAL ANNULOPLASTY FOR DCM,Diastole,Systole,Preop. (EF 11%),Postop. 1 mo. (EF 45%),MITRAL PLASTY FOR CARDIOMYOPATHY,No. of patients Operative mortality 2-year survival 5-year survivalIschemicNon-ischemic Contraindication,1506%72%52%39%60% Huge LV RV failure High PAP,Bolling. 2002,DOR,SAVE,DOR,SUMA,SAVE PROCEDURE (Suma),SAVE PROCEDURE,Preop.,Postop.,SVR + MAP for ICM,( 1998) ( 1998 ),STICH-Trial,NIH-funded ($ 40 Mio.),CAD-Patient, EF35%,Medical Therapy,CABG,CABG + SVR,Characteristics of 2,084 Randomized STICH Patients,3,6,60%,50%,x,x,SVR + CABG + MED,CABG + MED,Surgical Ventricular Restoration (SVR) Combined with CABG and MED Improves Survival Free of Cardiac Hospitalization Compared to CABG and MED without SVR,LV Restoration Hypothesis in 1,000 Patients LVEF 0.35, CAD Amenable to CABG, Dominant Anterior Akinesia or Dyskinesia Amenable to SVR,STICH-Trial: Hypothesis 2,postoperative years,Survival rate,89,81,71,SVR for ICM,n=246 Operative mortality 5.6%,(%),80.2,51,20,8,67.7,n 76,SVR + MV Reconstruction for ICM,%,postoperative months,Survival rate,38,Medical Tx. to IMR by Grigioni et. al.,CMRDCM with Akinetic Septum,SITE SELECTED VENTRICULOPLASTY,Akinesia & Fibrosis Septum Lateral,Lateral Septum,SAVE PLV,LV PLASTY FOR IDIOPATHIC DCM,Hospital mortality,All (%),Elective (%),Emergency (%),95 11 (11.6 ) 5/76 (6 .6) 6/19 (31.6),No. of pts,Survival rate,Postoperative months,72.8,50.5,61.4,60,n 95,13,32,P0.001,Selected ventriculoplasty for idiopathic dilated cardiomyopathy with advanced congestive heart failure -midterm results and risk analysis-,Hisayoshi Suma, Hiroaki Tanabe, Tokuhisa Uejima, Shinya Suzuki, Taiko Horii, Tadashi Isomura,European Journal of Cardio-thoracic Surgery 32(2007) 912-916,Fig. 1. Five-year survival curve following surgery.,Fig. 2. Five-year survival curves in patients with and without inotropic support before surgery.,LEFT VENTRICULOPLASTY FOR IDIOPATHIC DCM,LEFT VENTRICULOPLASTY FOR IDIOPATHIC DCM,(l/min/m2),(pg/ml),1000,500,0,Preop.,Preop. 1 mo.,1 yr,2 yrs,3 yrs,898,629,413,229,4,3,2,1,0,Preop.,Preop. 1 mo.,1 yr,2 yrs,3 yrs,n 35 33 23 18 6,2.3,3.3,2.8,2.8,2.7,362,CI,BNP,n 41 33 23 15 7,CONCLUSION,Ventriculoplasty and mitral annuloplasty is an effective option for advanced cardiomyopathy. Proper patient selection, choice of procedure and timing of surgery are important to improve the results.,谢谢、下次再见！,心脏血管研究所 须 磨 久 善,SURGERY FOR IDIOPATHIC DCM WITH MR,LVDd (mm) 65,65 74, 75,R-MAP,R-MAP + Cor Cap,R-MAP + LVP,