“Frozen Apex” Repair of a Dilated Cardiomyopathy

• Published in: Seminars in thoracic and cardiovascular surgery 2018, Vol.30 (4), p.406-411
• Main Authors: Komeda, Masashi, Uchiyama, Hirotomo, Fujiwara, Shoji, Ujiie, Toshimi
• Format: Article
• Language: English
• Subjects: Aged; Cardiac Surgical Procedures - adverse effects; Cardiomyopathy, Dilated - diagnostic imaging; Cardiomyopathy, Dilated - physiopathology; Cardiomyopathy, Dilated - surgery; dilated cardiomyopathy; Female; functional mitral regurgitation; Humans; ischemic cardiomyopathy; left ventricular aneurysm; Male; Middle Aged; Mitral Valve - physiopathology; Myocardial Contraction; Operative Time; Recovery of Function; surgical ventricular restoration; Suture Techniques - adverse effects; Time Factors; Treatment Outcome; Ventricular Function, Left; Ventricular Function, Right
• ISSN: 1043-0679; 1532-9488
• DOI: 10.1053/j.semtcvs.2018.07.003

We try to make surgical ventricular restoration simpler and more adjustable to safely enhance ventricular function. In eight patients with DiDonato type III dilated cardiomyopathy, we applied a few short-axis purse-string sutures to the endocardial side of the left ventricular apex ("Frozen-Apex" restoration) to make a smaller, cone-shaped apex, based on the concept that the left ventricular apex is important in its existence, but not in its function. The procedure took less than 15 minutes in all the patients. There was no hospital or late death with the follow-up of 549 ± 389 days. Mid-late postoperatively, New York Heart Association functional class changed from 3.5 ± 0.8 (preoperative) to 1.6 ± 0.6 (P = 0.000 vs preoperative), left ventricular diastolic diameter from 64 ± 16 to 61 ± 15 mm, systolic diameter from 57 ± 15 to 50 ± 17mm (P = 0.070), ejection fraction from 27 ± 10 to 40 ± 16% (P = 0.014). Diastolic function as assessed by the ratio of the early to late ventricular filling velocities, the ratio of mitral annular early diastolic velocity to early mitral inflow velocity, and estimated right ventricular pressure remained at the similar level to preoperative one. The new ventricular restoration was associated with better systolic left ventricular function without deteriorating diastolic one. It may improve the outcome of the treatment of selected patients with dilated cardiomyopathy.