Objective: We present a group of patients with end stage ischemic cardiomyophaty, operated with a combined procedure, involving myocardial revascularization, mitral valve anuloplasty and ventriculoplasty. Material and Methods: Twenty seven patients, 22 males, whose mean age was 57.8 years. The majority were in NYHA classes III and IV and had a mean ejection fraction of 15%. Eight patients had IABP inserted preoperatively. CPB, temperature 32° C and warm blood cardioplegia. Twenty-six received 74 grafts (3.1 per patient). 10 had Mitral anuloplasty and 4 Mitral and Tricuspid. Two cases had plication of the LV and 18 DOR procedure. The mean X-clamp time 59m and CPB time 145m. Ten patients came off Bypass on IABP and 25 required inotropic support. Results: There was no theatre mortality. Mean ventilation time 31.7h and mean ICU time 65.7h. Three patients required reventilation, 2 reexploration for bleeding, 8 developed AF and 1 had a stroke. The mean hospital stay was 13 days and 6 patients (22.2%) died in hospital. The main cause of death was low cardiac output syndrome. The minimal follow-up was 10 months and the maximum was 47 months (mean 20.7 months). Two patients died on this period. Nineteen patients were followed-up. Nineteen patients are alive (70.3%). fifteen are in NYHA class I, 2 in class II and 2 in class III. None had MI. Five patients were readmitted. The reasons for admissions were in 2 cases for AF, 2 cases angina and in 3 patients CHF. Conclusion: The cardiac surgical remodeling has high hospital mortality, but acceptable morbidity and reasonable hospital stay. The median term survival is also very acceptable giving the patients a better clinical status.
Cardiac surgical procedures; Myocardial ischemia