Left ventricular reconstruction benefits patients with dilated ischemic cardiomyopathy

Since the preoperative left ventricular end-systolic volume index (LVESVI) of greater than 100 mL/m2 was demonstrated to be an independent predictor of long-term mortality following isolated coronary artery bypass grafting (CABG), LV reconstruction (LVR) has been concomitantly performed in patients with a dilated LV due to ischemic cardiomyopathy.

We retrospectively assessed the ability of preoperative and intraoperative variables to affect the actuarial survival in 48 patients with a preoperative LV ejection fraction (EF) of less than 0.30 and a preoperative LVESVI of greater than 100 mL/m2. Mean preoperative LVEF was 0.22 +/- 0.07, and preoperative LVESVI was 121 +/- 28 mL/m2. Coronary artery bypass grafting was performed in all patients. Mean number of grafted vessels was 2.8. The LVR was concomitantly performed in 20 patients and mitral valve plasty in 11. Preoperative and intraoperative variables were exposed to univariate and multivariate analyses.

There were 3 hospital deaths and 17 late deaths during the follow-up period. Causes of deaths were pump failure (9), myocardial infarction (2), ventricular arrhythmia (4), cerebral infarction (2), and cancer (2). Cox's proportional hazards model identified LVR and renal failure as independent factors, which affected the actuarial survival with odds ratios of 0.28 and 3.64 (p < 0.05). The 5-year actuarial survival (Kaplan-Meier) was significantly greater following LVR (90% +/- 11%) compared to isolated CABG (53% +/- 17%).

Left ventricular reconstruction contributed to improve the actuarial survival in patients with dilated ischemic cardiomyopathy, which could not be achieved by isolated CABG. The LVR can be an alternative to heart transplantation for the treatment of ischemic cardiomyopathy.