LEFT VENTRICULOPLASTY FOR ENDSTAGE CARDIOMYOPATHY HISAYOSHI SUMA THE CARDIOVASCULAR INSTITUTE TOKYO THE CARDIOVASCULAR INSTITUTE TOKYO.

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Presentation transcript:

LEFT VENTRICULOPLASTY FOR ENDSTAGE CARDIOMYOPATHY HISAYOSHI SUMA THE CARDIOVASCULAR INSTITUTE TOKYO THE CARDIOVASCULAR INSTITUTE TOKYO

LEFT VENTRICULOPLASTY lSCHEMIC CARDIOMYOPATHY -EVCPP(Dor), SAVE(Suma) NON ISCHEMIC CARDIOMYOPATHY -PLV(Batista), SAVE(Suma)

ISCHEMIC CARDIOMYOPATHY Definition: Non-aneurysmal diffuse akinetic left ventricle with chronic heart failure following myocardial infarction Diastole Systole (EF 6%)

ISCHEMIC CARDIOMYOPATHY Trias of “ Bad ” ventricle Dilated LV Intractable heart failure No angina pectoris

Years since operation n = 57 EF < 35% CABG FOR ISCHEMIC CARDIOMYOPATHY Shah et.al. JTCVS 2OO3; 126: Estimate of Survival 50% 20%

SAVE operation

Septal Anterior Ventricular Exclusion

SAVE FOR DCM Preop. Postop. EF (%) EDVI (ml /m 2 ) ESVI (ml /m 2 ) BNP (pg/ml) EF (%) EDVI (ml /m 2 ) ESVI (ml /m 2 ) BNP (pg/ml)

SAVE FOR DCM Preop. Postop. LVEDP(mmHg) PAP (mmHg) 11 28/ /15

LEFT VENTRICULOPLASTY FOR ISCHEMIC CARDIOMYOPATHY 100 (%) Survival Rate Postoperative years No MR (n=68) MR > 2 + (n=56) = - HAYAMA HEART CENTER -

VENTRICULOPLASTY FOR IDIOPATHIC DCM - Actuarial Survival Curve Survival Rate (%) Postoperative Years n = 96

VENTRICULOPASTY FOR DCM (%) Survival Rate Postoperative Years 50 LVP No inotropes LVP Preop. inotropes LVAS REMATCH Medical Treatment

LEFT VENTRICULOPLASTY FOR IDIOPATHIC DCM (%) Preop. Preop. 1 mo.1 yr2 yrs3 yrs n (mmHg) Preop. Preop. 1 mo.1 yr2 yrs3 yrs n EF LVEDP

LEFT VENTRICULOPLASTY FOR IDIOPATHIC DCM (l/min/m 2 ) (pg/ml) Preop. Preop. 1 mo.1 yr2 yrs3 yrs Preop. Preop. 1 mo.1 yr2 yrs3 yrs n CI BNP n

LVAD LV Plasty HTX Ongoing shock Valve Repair Small LV RV CM