[Myocardial protection during left-ventricular reconstruction in patients with an ejection fraction below 30]

Surgical reconstruction of the left ventricle is an effective method of treatment for ischaemic cardiomyopathy. One of the conditions of successful intervention is correctly choosing a method of intraoperative myocardial protection. Currently, two techniques of myocardial protection are used: cardioplegic cardiac arrest and continuous myocardial perfusion on the beating heart. A series of experimental studies demonstrated that myocardial oxygen requirements in ischaemic cardiomyopathy during permanent perfusion are three times higher than during cardioplegic cardiac arrest. However, the technique of continuous myocardial perfusion in conditions of the beating heart makes it possible to prevent ischaemia of the most sensitive subendocardial layers of the myocardium. In order to determine optimal strategy of myocardial protection during surgical reconstruction of the left ventricle we retrospectively assessed therapeutic outcomes in a total of 136 patients presenting with ischaemic cardiomyopathy, an ejection fraction below 30%, and an end-systolic volume index of more than 100 ml/m2. The patients were divided into two groups: group 1 (n=44) subjected to reconstruction of the left ventricle performed on the beating heart and group 2 (n=92) undergoing surgery in conditions of cardioplegic cardiac arrest. We examined early and medium-term clinical and echocardiographic results (30-day mortality, postoperative complications, medium-term survival, and probability of the development of major adverse cardiac and cerebrovascular events (MACCE)). It was determined that short- and medium-term clinical and echocardiographic results of surgical reconstruction of the left ventricle in patients with an ejection fraction less than 30% do not depend on the method of myocardial protection (continuous myocardial perfusion in conditions of the beating heart or crystalloid cardioplegia).