缺血性和非缺血性心肌病的外科治疗

Non-transplant surgical treatment for ischemic and non-ischemic cardiomyopathy,Hayama Heart Center Tadashi Isomura, Jyoji Hoshino, Yasuhisa Fukada, Shintaro Katahira,Operation for DCM (Dilated cardiomyopathy),Surgical treatment for ischemic or non-ischemic dilated cardiomyopathy (DCM) is a challenging treatment. Left ventricular restoration (LVR) or valve surgery with other aggressive treatment was conducted and evaluated.,Dyskinesis=LV aneurysm,Akinesis=Ischemic DCM,Dor. V; Current Opinion in Cardiology 1997, 12: 534,ICM : LV Remodeling,DCM,noMR Preop LVG,Non-ischemic DCM,CAG, LVG, Biopsy Cardiac echo :Color kinesis Scintigram Cine-MRI Speckle tracking image Radial, Circumferential, Longitudinal,Examination before operation,Radial Strain,Septal,Lateral,Posterior,Normal,Septal,Lateral,Posterior,Normal Heart,Speckle tracking image : Circumferential strain,DCM,Normal,DCM (n=466) 19972008.7,Operative procedures for DCM Left Ventricular Restoration (LVR) EVCPP (Dor), SAVE, PLV (Batista) Mitral Valve Surgery CABG CRT-D, Cryoablation ,EVCPP（Dor), SAVE、PLV(Batista),LVR,Indication for SAVE,Indication for PLV,SAVE（Septal anterior Ventricular Exclusion with large patch）,Ischemic DCM (n=176),19972008.7,Surgical procedures for Non-ischemic DCM,-2006.5,With LVR (n=168),Without LVR (n=122),Surgical results for DCM (N=466),Prognosis of CHF of Stage C,Circulation 2007;115:1563-1570 Prevalence of CHF in the Community- Ammar KA et al.,1,0,0.2,2,3,4,5,6,7,Survival rate,0.4,0.6,0.8,1.0,years,0,A,B,C1,C2,Circulation 2007;115:1563-1570 Prevalence of CHF in the Community- Ammar KA et al.,1,0,0.2,2,3,4,5,6,7,Survival rate,0.4,0.6,0.8,1.0,years,0,A,B,C1,C2,D,Prognosis of CHF of Stage D,0,2,4,6,8,10,12,1.0,0.8,0.6,0.2,0.0,Years since operation,ICM and solo CABG A prospective ten-year follow-up,Shah et.al. JTCS 2OO3; 126:1320 - 7,0.4,Estimate of Survival,57,EF 35%,n =,20.3%,55.7%,Conclusion:Revascularization may have the advantage of preserving the remaining left ventricular function. However, the long-term mortality remains high.,Survival Rate (%),1.0,0.1,0.2,0.3,0.4,0.5,0.6,0.7,0.8,0.9,0.0,1 2 3 4 5 6 7,SAVE 63.4,EVCPP 55.6,ICM and LVR ICM SAVE or EVCPP follow-up,EVCPP 85.6,SAVE 86.0,2000.5-,1997-,2000.52007.6,CRT-OFF,Radial Strain,35M,DCM:SAVE,MVP,CRT,Septal,Lateral,Posterior,SAVE+CRT and Stain,CRT-ON,Radial Strain,35M,DCM:SAVE,MVP,CRT,Septal,Lateral,Posterior,SAVE+CRT and Stain,Batista operation (PLV)?,Modified Batista Operation Indication=Posterolateral akinesis with speckle tracking echo 1. Partial left ventriculectomy at the posterior wall between bilateral papillary muscle (Volume reduction) 2. Papillary muscle plication (Preservation of papillary muscle-mitral valve continuity） 3.Cryoablation at the cut edge and mitral annulus (Prevention of macro-reentry),Mid-SAX; Circumferential strain,Pre,Post,Lengthening,Lengthening,Shortening,Shortening,-15%,PLV,postop,PLV,preop,PLV and Stain,Survival Rate (%),6,PLV 36.5,SAVE 52.1,Valve 58.4,0.0,Non-ischemic DCM follow-up,Modified Batista 93.75（N=24),years,Mitral surgery for Functional MR?,Intra-operative volume test for MR,Volume Reduction,Volume Loading,Presence of MR,Surgical treatment for ischemic MR,Does the mitral trigone dilate in ischemic MR?,The mitral trigone dose dilate.,JTCS 124 No.6 1216-1224,LV dilatation,Ischemia,LV EDP,Two undersized ring annuloplasty =Improve annular dilatation Papillary muscle plication =Improve mitral tethering,Mitral Valve Plasty,Dilated cardiomyopathy Papillary muscle plication,In non-ischemic DCM preoperative status was more severe than that of ischemic DCM and the late results showed better in ischemic DCM than those in non-ischemic DCM. However, aggressive non-transplant surgical treatment with LVR or valve surgery can be useful for indicated patients with both ischemic and non-ischemic DCM.,Conclusion2-1,Surgic