Surgery for endomyocardial fibrosis revisited

Area of Science:

• Cardiology
• Cardiac Surgery
• Cardiovascular Research

Background:

• Endomyocardial fibrosis (EMF) is a restrictive heart disease characterized by fibrosis of the endocardium.
• Patients with EMF often present in advanced functional classes (III or IV) due to the progressive nature of the disease.

Purpose of the Study:

• To determine the life expectancy of patients following surgical intervention for endomyocardial fibrosis (EMF).
• To identify key events and factors influencing survival rates after EMF surgery.

Main Methods:

• A cohort of 83 patients with EMF underwent endocardial decortication and atrioventricular valve surgery between 1977 and 1997.
• Patient demographics, disease distribution (biventricular, right ventricle alone, left ventricle alone), and functional class were recorded.
• Follow-up data were collected to assess survival, recurrence, reoperations, and functional status.

Main Results:

• The study included 83 patients (66 female, 17 male), aged 4-59 years, all in NYHA functional class III or IV.
• Sixty-eight patients (81.9%) survived surgery. The 17-year actuarial survival probability, including operative mortality, was 55%.
• Late deaths occurred in 15 patients. Recurrence or new-onset EMF in the contralateral ventricle was observed in 14.5% of patients, necessitating reoperation in some cases.

Conclusions:

• Surgical treatment for EMF is palliative, as it does not halt the disease's progressive nature.
• Despite its palliative nature, surgical therapy is recommended for EMF patients with heart failure, offering them the sole chance for survival.