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Left ventricular reconstruction brings benefit for patients with ischemic cardiomyopathy
Gustavo C Aguiar Ribeiro1, Fernando Antoniali, Mauricio M Lopes
1Department of Cardiothoracic Surgery, Clinic of Cardio-Surgery at Campinas, Brazil.
Insights
Ventricular reconstruction combined with revascularization improves outcomes for ischemic cardiomyopathy patients. This surgical approach led to better heart function and fewer heart failure recurrences compared to revascularization alone.
Area of Science:
- Cardiovascular Surgery
- Cardiac Reconstruction
- Ischemic Cardiomyopathy
Background:
- Optimal treatment for ischemic cardiomyopathy remains unclear.
- Comparison of revascularization alone versus revascularization with ventricular reconstruction is needed.
Purpose of the Study:
- To compare midterm outcomes of revascularization only versus revascularization plus ventricular reconstruction in patients with ischemic cardiomyopathy.
- To evaluate the impact of additional ventricular reconstruction on ejection fraction, heart failure symptoms, and mortality.
Main Methods:
- A comparison of 74 patients with ejection fraction <35% and left end-systolic volume index >80 mL/m(2).
- Patients underwent revascularization, with one group receiving only revascularization and the other receiving additional ventricular reconstruction.
- Key outcomes including ejection fraction, end-systolic volume, mitral regurgitation, mortality, and heart failure recurrence were assessed.
Main Results:
- Postoperative ejection fraction significantly improved in the ventricular reconstruction group (P < .001).
- The ventricular reconstruction group showed a greater decrease in heart failure class (P < .001) and significantly less HF recurrence and rehospitalization (P = .028).
- Higher-grade mitral regurgitation developed more frequently in the revascularization-only group (P = .024).
Conclusions:
- Additional ventricular restoration combined with coronary artery surgery offers superior midterm outcomes compared to revascularization alone in patients with large preoperative left ventricles.
- Ventricular reconstruction is associated with improved cardiac function and reduced heart failure burden.
Background:
Optimal treatment strategies for some patients with ischemic cardiomyopathy can be unclear. We compared the outcome for patients treated with revascularization only or with additional ventricular reconstruction.
Methods And Results:
We compared 74 consecutive patients with an ejection fraction <35% and a left end-systolic volume index >80 mL/m(2). All patients underwent revasularization but some received only revascularization (group 1) and some were randomized into a group that received additional ventricular reconstruction (group 2). Preoperative and postoperative ejection fraction, end-systolic volume, mitral regurgitation, mortality, heart failure (HF) symptoms, and recurrence were compared between groups. There was 1 postoperative death in group 2 (P =. 58). Preoperative ejection fraction between the groups was similar (P =. 19) but it differed significantly postoperatively (P < .001). HF class (New York Heart Association) decreased more in group 2 (group 2, 2.3 +/- 0.4 versus group 1, 1.4 +/- 0.4; P < .001). Incidence of HF recurrence and rehospitalization was significantly less in group 2 (P = .028). The postoperative development of higher-grade mitral regurgitation was greater in group 1 (147 +/- 32 mL/m(2) versus 119 +/- 25 mL/m(2), P = .024).
Conclusion:
The outcome at midterm of coronary artery surgery alone in patients with a preoperative large left ventricle was inferior compared with the outcome achieved with additional ventricular restoration.
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