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Left ventriculoplasty for ischemic cardiomyopathy
1Department of Cardiovascular Surgery, Hayama Heart Center, 1898 Shimoyamaguchi, Hayama, Kanagawa 240-0116, Japan. mail@hayamaheart.gr.jp
Insights
Endoventricular circular patch plasty (EVCPP) effectively treats ischemic cardiomyopathy by improving left ventricular function and patient outcomes. This surgical procedure excludes akinetic segments, enhancing heart function and quality of life for patients with chronic heart failure.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Regenerative Medicine
Background:
- Ischemic cardiomyopathy results from myocardial infarction, leading to chronic heart failure.
- Characterized by a non-aneurysmal, diffuse akinetic left ventricle.
- Significant impact on patient morbidity and mortality.
Purpose of the Study:
- To evaluate the mid-term efficacy of endoventricular circular patch plasty (EVCPP).
- To assess improvements in left ventricular function and clinical status.
- To determine the impact on patients with ischemic cardiomyopathy.
Main Methods:
- A cohort of 54 patients with ischemic cardiomyopathy underwent EVCPP.
- Concomitant procedures included coronary artery bypass grafting (94%) and mitral valve reconstruction (35%).
- Pre- and post-operative left ventricular function, volumes, and clinical status were analyzed.
Main Results:
- Hospital mortality was 12.9%, with higher rates in emergency cases.
- Late deaths occurred in 11.1% of patients.
- Survivors showed significant improvement: ejection fraction increased from 22.8% to 36.2%, LV volumes reduced, and 88% improved to NYHA class I or II.
- 1-, 2-, and 3-year actuarial survival rates were 87.9%, 82.7%, and 77.2%.
Conclusions:
- EVCPP is effective in excluding akinetic left ventricular segments.
- The procedure significantly improves left ventricular function.
- EVCPP leads to enhanced clinical status in patients suffering from ischemic cardiomyopathy.
Objective:
In order to treat ischemic cardiomyopathy, which is defined as non-aneurysmal diffuse akinetic left ventricle with chronic heart failure following myocardial infarction, the mid-term effect of the endoventricular circular patch plasty (EVCPP) was studied.
Materials And Methods:
EVCPP has been performed on 54 patients (46 men and eight women with a mean age of 61 years) during 4 years from March 1997 to December 2000. Thirty-two patients (59%) were NYHA class III and 22 patients (41%) were class IV. Nine patients (17%) had mild angina pectoris before the operation but others had no chest pain. Single, double, triple, and left main disease were noted in six, 13, 32, and three patients, respectively. Mean left ventricular ejection fraction was 23.3 +/- 6.3% (6--30%). Coronary artery bypass grafting was concomitantly undergone by 51 patients (94%) and mitral valve reconstruction was done on 19 patients (35%).
Results:
Two patients (3.7%) needed an intra-aortic balloon pump to wean from cardiopulmonary bypass. Seven patients (12.9%) died in the hospital. Among them, two patients (4.4%) out of 45 patients who underwent elective operation died of stroke and heart failure. Five patients (55.5%) out of nine patients who required emergency operation died of heart failure and multiorgan failure. Late death occurred in six patients (11.1%) due to arrhythmia and heart failure in each of three patients. Out of 41 survivors, 38 patients returned to NYHA class I or II and three patients to class III. Out of 50 patients who underwent left ventricular study before and after operation, ejection fraction increased from 22.8 +/- 6.6 to 36.2 +/- 8.0% and mean left ventricular end-diastolic volume and left ventricular end-systolic volume indices reduced from 152.8 +/- 24.6 to 105.0 +/- 36.5 and from 113.6 +/- 45.7 to 66.4 +/- 28.4 ml/m(2), respectively. Mean pulmonary wedge pressure decreased from 19.1 +/- 8.8 to 14.9 +/- 6.8 mmHg. One-, 2-, and 3-year actuarial survival rates were 87.9, 82.7 and 77.2%, respectively.
Conclusion:
Left ventriculoplasty using EVCPP is effective to exclude the akinetic LV segment, and left ventricular function and clinical status improve in patients with ischemic cardiomyopathy.