Simultaneous operation for cardiac disease and gastrointestinal malignancy

AIM: To investigate the safety of performing simulta-neous cardiac surgery and a resection of a gastrointes-tinal malignancy. METHODS: Among 3664 elective cardiac operations performed in adults at Kagoshima University Hospi-tal from January 1991 to October 2009, this study reviewed the clinical records of the patients who un-derwent concomitant cardiac surgery and a gastroin-testinal resection. Such simultaneous surgeries were performed in 15 patients between January 1991 and October 2009. The cardiac diseases included 8 cases of coronary artery disease and 7 cases with valvular heart disease. Gastrointestinal malignancies included 11 gas-tric and 4 colon cancers. Immediate postoperative andlong-term outcomes were evaluated. RESULTS: Postoperative complications occurred in 5 patients(33.3%), including strokes(n = 1), respiratory failure requiring re-intubation(n = 1), hemorrhage(n = 2), hyperbilirubinemia(n = 1) and aspiration pneu-monia(n = 1). There was 1 hospital death caused by the development of adult respiratory distress syndrome after postoperative surgical bleeding followed aortic valve replacement plus gastrectomy. There was no car-diovascular event in the patients during the follow-up period. The cumulative survival rate for all patients was 69.2% at 5 years. CONCLUSION: Simultaneous procedures are accept-able for the patients who require surgery for both car-diac diseases and gastrointestinal malignancy. In par-ticular, the combination of a standard cardiac operation, such as coronary artery bypass grafting or an isolated valve replacement and simple gastrointestinal resection, such as gastrectomy or colectomy can therefore be safely performed.

Ventricular Approach for Functional Mitral Regurgitation in Cardiomyopathy

Background: The key mechanism of functional mitral regurgitation (FMR) in cardiomyopathy is leaflet tethering caused by displacement of the papillary muscles (PM) due to left ventricular dilatation. The attendant remodeling process is characterized by intraventricular widening between both PM. Recently, surgical ventricular restoration (SVR) has been proposed as a technique to reduce leaflet tethering by improving ventricular geometry. However, it is unknown how SVR improve FMR. Methods and Results: From 2003 to 2010, we surgically treated FMR in 100 patients with idiopathic dilated cardiomyopahy (DCM) or ischemic cardiomyopathy (ICM). Of those, we performed posterior wall exclusion procedures by either resection (the Batista procedure, n = 13) or plication (n = 19) to approximate papillary muscle distance in a total of 32 patients (DCM in 17, ICM in 15), and these patients formed the cohort of this study. There were two 30-day mortalities (6.3%). There was no significant change in left ventricular ejection fraction, however, the size of the left ventricle, degree of MR, tethering height and distance of PM significantly decreased after operation and well maintained at the mean follow up of 3.3 ± 2.1 years. Conclusions: Posterior wall resection or plication with PM approximation provides excellent reduction of leaflet tethering and MR. Thus, reduction of PM distance may be helpful to treat FMR due to leaflet tethering.