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1、Non-transplant surgical treatment for ischemic and non-ischemic cardiomyopathy,Hayama Heart CenterTadashi 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 trea
2、tment.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,noMRPreop LVG,Non-ischemic DCM,CAG,LVG,BiopsyCardiac echo:Color kine
3、sisScintigramCine-MRISpeckle 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 DCML
4、eft Ventricular Restoration(LVR)EVCPP(Dor),SAVE,PLV(Batista)Mitral Valve SurgeryCABGCRT-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-ische
5、mic 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;115:1563-1570Prevalence 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;115:1563-1570Prevalence
6、 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 CABGA prospective ten-year follow-up,Shah et.al.JTCS 2OO3;126:1320-7,0.4,Estimate of Survi
7、val,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(%),1.0,0.1,0.2,0.3,0.4,0.5,0.6,0.7,0.8,0.9,0.0,1234567,SAVE63.4,EVCPP55.6,ICM and LVR ICMSAVE or EVCPP fo
8、llow-up,EVCPP85.6,SAVE86.0,2000.5-,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 OperationIndication=Posterolater
9、al akinesis with speckle tracking echo1.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-r
10、eentry),Mid-SAX;Circumferential strain,Pre,Post,Lengthening,Lengthening,Shortening,Shortening,-15%,PLV,postop,PLV,preop,PLV and Stain,Survival Rate(%),6,PLV 36.5,SAVE52.1,Valve 58.4,0.0,Non-ischemic DCM follow-up,Modified Batista 93.75（N=24),years,Mitral surgery for Functional MR?,Intra-operative vo
11、lume 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 dilatationPapillary
12、 muscle plication=Improve mitral tethering,Mitral Valve Plasty,Dilated cardiomyopathyPapillary 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-t
13、ransplant surgical treatment with LVR or valve surgery can be useful for indicated patients with both ischemic and non-ischemic DCM.,Conclusion2-1,Surgical treatment for ischemic or non-ischemic dilated cardiomyopathy(DCM)is a challenging treatment.The development of the procedures does improve the operative and long-follow-up results.,Conclusion2-2,
