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The results of combination of coronary artery bypass grafting with circular plasty of left ventricular and mitral valve annuloplasty.

BACKGROUND
Patients with ischemic cardiomyopathy (ICMP) represent a severe loss ontractile function of left ventricular (LV) because of remodeling of fibrous skeleton of the heart with following dilatation of LV. The aim of this study was to evaluate the results of surgical treatment of patients with ICMP, who had underwent coronary artery bypass grafting (CABG) and new methods of LV reconstruction, called as LV circular plasty (LVCP), in 60% cases associated with mitral valve annuloplasty.


MATERIALS AND METHODS
There were 15 patients (males, mean age - 48.9+/-3.9 years, mean EuroScore - 4.63+/-3.9, average number of grafts - 2.41+/-0.01). With specially developed mathematical model using data of echocardiography (ECHO) three maximal diameters of LV (on basal level, on level of papillar muscles and 3 cm apically from papillary muscles), maximal length of LV and maximal end-diastolic volume of LV (LVEDV) were defined. Reconstruction of LV cavity was performed by putting endoventricular sutures. The location and diameter of sutures was defined by ECHO.


RESULTS
The mean NYHA functional class decreased from 2.9+/- to 2.0 postoperatively. Exercise capacity: 6-minute walking test (from 387.56+/-0.71 m to 540.39+/-0.62 m) also significantly improved. The LVEDV decreased from 223.5+/-1.7 ml to 134.6+/-0.9 ml, LVESV - from 145.2+/-0.7 ml to 77.2+/-0.51 ml, mean LVEF increased from 34.5+/-0,4% to 41.6+/-0.1%, spherical index increased from 1.2 +/-0.01 to 1.8+/-0.01, mitral regurgitation decreased from 2.33+/-0.31 to 1.01+/-0.03, mean pulmonary artery pressure decreased from 47.81+/-0.07 to 34.11+/-0.070. The hospital mortality rate was 10%.


CONCLUSION
Combination of CABG with LVCP and annuloplasty allowed to decrease also significantly improved LV volume and to change spherical geometry of LV, to improve systolic function of LV and clinical status of patients with ICMP.