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Volume reduction rate by surgical ventricular restoration determines late outcome in ischaemic cardiomyopathy

Tadashi Isomura1, Joji Hoshino, Yasuhisa Fukada

  • 1Division of Cardiovascular Surgery, Hayama Heart Center, Hayama, Japan.

European Journal of Heart Failure
|February 15, 2011
PubMed

Insights

Surgical ventricular restoration (SVR) is most effective for ischaemic cardiomyopathy (ICM) when it achieves a left ventricular (LV) end-systolic volume index (ESVI) below 90 mL/m(2) with over 33% volume reduction. Achieving less than 15% reduction offers no long-term survival benefit.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Heart Failure Management

Background:

  • Surgical ventricular restoration (SVR) is a procedure to reduce left ventricular (LV) volume in patients with ischaemic cardiomyopathy (ICM).
  • The importance of SVR has been questioned by the Surgical Treatment of Ischemic Heart Failure (STICH) Trial.
  • Long-term outcomes of SVR in ICM patients require further investigation.

Purpose of the Study:

  • To report an 8-year experience with SVR in patients suffering from ICM.
  • To evaluate the effectiveness of SVR based on the degree of LV volume reduction and its impact on long-term survival.
  • To compare the findings with the results of the STICH trial.

Main Methods:

  • Analysis of data from 90 ICM patients who underwent SVR between 2000 and 2008.
  • Pre- and post-operative assessment of LV volumes using left ventriculogram or scintigram, supplemented by echocardiograms.
  • Categorization of patients based on post-operative LV end-systolic volume index (ESVI) and percentage of LV volume reduction.

Main Results:

  • The study included 90 patients with ICM, with pre-operative LV end-systolic volume index (ESVI) of 123.5 ± 53.2 mL/m(2).
  • Patients achieving >33% LV volume reduction and post-operative ESVI < 90 mL/m(2) (Group-S) had an 8-year survival rate of 82.4%.
  • Patients with <15% LV volume reduction and residual ESVI >90 mL/m(2) (Group-M and Group-L) experienced 100% mortality within 7 years.

Conclusions:

  • SVR is highly effective in ICM when it achieves a significant LV volume reduction (>33%) leading to an ESVI < 90 mL/m(2).
  • SVR provides no long-term survival benefits if LV volume reduction is minimal (<15%) with a residual ESVI >90 mL/m(2).
  • These findings contradict the conclusions of the STICH trial regarding the efficacy of SVR in ICM.
Abstract

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