Noncardioplegic Surgery for Ischemic Mitral Regurgitation
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概要
- 論文の詳細を見る
Twenty-seven consecutive patients underwent surgery for ischemic mitral regurgitation (MR): papillary muscle rupture, papillary muscle dysfunction and annular dilatation. The grade of MR was moderate or severe, and the ejection fraction (EF) was less than 30% in 8 patients (mean, 43%). Three cases were reoperation and 3 were emergencies. Under ventricular fibrillation (VF) and intermittent aortic cross-clamping at moderate hypothermia, coronary artery bypass grafting (CABG) was performed first, followed by the mitral procedure through a right-sided left atriotomy (repair 21, replacement 6) performed under VF with the heart perfused through the native coronary arteries and CABG grafts. Concomitant procedures were CABG, Dor's procedure, and tricuspid annuloplasty. In one reoperative case with cardiogenic shock, CABG was impossible because of dense adhesions and the patient died just after surgery (hospital mortality, 3.7%). Five patients required intra-aortic balloon pump (IABP) support intraoperatively, but none required prolonged (≥7 days) inotropic support or IABP use, although the serum concentrations of creatine kinase and its myocardial fraction were elevated remarkably. Other morbid events were refractory ventricular arrhythmia in one case and stroke in another. Median duration of mechanical ventilation and intensive care unit stay was 8 h and 3 days, respectively. Mean EF at hospital discharge was 48%. The extended period of VF was not associated with unfavorable clinical outcomes. Noncardioplegic surgery for ischemic MR was carried out with acceptable mortality and morbidity, and can be a good altemative, especially when clamping the aorta is undesirable.
- 社団法人日本循環器学会の論文
- 2002-12-20
著者
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KYO Shunei
Department of Cardiothoracic Surgery, The University of Tokyo
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荻原 正規
公立昭和病院心臓血管外科
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ASANO Haruhiko
Department of Hematology and Oncology, Nagoya University Graduate School of Medicine
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Tanabe Hiroaki
Department of Cardiovascular Surgery, The Cardiovascular Institute Hospital
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Tanabe Hiroaki
Department Of Cardiovascular Surgery Saitama Medical School
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GOJO Satoshi
Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of
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Kyo Shunei
Department Of Cardiovascular Surgery Saitama Medical University
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Kyo Shunei
Department Of Cardiac Surgery Saitama Medical School
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Gojyo Satoshi
Department Of Cardiovascular Surgery Saitama Medical University
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Gojo Satoshi
Department Of Cardiovascular Surgery Saitama Medical Center
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Kato Masaaki
Department of Cardiovascular Surgery, Morinomiya Hospital
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Ohuchi Hiroshi
Department Of Cardiovascular Surgery Saitama Medical School
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Asano Haruhiko
Department Of Cardiovascular Surgery Saitama Medical School
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Kato Masaaki
Department Of Cardiovascular Surgery Saitama Medical School
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Imanaka Kazuhito
Department of Cardiovascular Surgery, Kawagoe Medical Center, Saitama Medical University
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YOKOTE YUJI
Department of Pediatric Cardiology and Cardiovascular Surgery, Saitama Heart Institute, Saitama Medi
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Ogiwara Masanori
Saitama Medical School
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OGIWARA Masanori
Department of Cardiovascular Surgery, Saitama Medical School
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Yokota Yuji
Saitama Medical School
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Gojyou Satoshi
Department Of Cardiovascular Surgery Saitama Medical University
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Kyo Shunei
Fujiyoshida Municipal hospital
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Ogiwara Masanori
Department Of Cardiothoracic Surgery Saitama Medical School
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Ogiwara Masanori
Department Of Cardiovascular Surgery Saitama Medical School
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Imanaka Kazuhito
Department Of Cardiovascular Surgery Kawagoe Medical Center Saitama Medical University
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Imanaka Kazuhito
Department Of Cardiothoracic Surgery The University Of Tokyo
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Yokote Yuji
The Department Of Surgery Saitama Medical School
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Kyo Shunei
Department Of Cardiovascular Surgery Saitama Medical School
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Asano Haruhiko
Department Of Biomedical Sciences Chubu University
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Ohuchi Hiroshi
Department Of Cardiovascular Surgery
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Ohuchi Hiroshi
Department Of Cardiovascular Surgery Saitama Medical Center Saitama Medical School
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Kato Masaaki
Department Of Cardiovascular Surgery Morinomiya Hospital
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Shimomura Katusro
National Cardiovascular Center Division Of Cardiology
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