Long-term results of left ventricular reconstructive surgery in patients with ischemic dilated cardiomyopathy - A multicenter study

Abstract

Background: Left ventricular restoration (LVR) is increasingly used for treatment of chronic heart failure following myocardial infarction. The present multi-institutional retrospective study analyzed the long-term efficacy and limitations of LVR. Methods and Results: Seventy-two (58 males, mean age 62±10) patients who underwent LVR between January 1999 and June 2007 were included. Preoperatively, 50 (68.5%) were in New York Heart Association (NYHA) functional class III or IV. Mean left ventricular end-diastolic and end-systolic volume indexes were 145±43 ml/m2 and 111±40 ml/m 2, respectively, and ejection fraction was 25±7.4%. Other concomitant operative procedures included coronary artery bypass grafting in 55 (76.4%), and mitral valve procedures in 38 (52.8%). Thirty-day mortality was 2.8%. Actuarial survival at 1, 3, and 5 years was 95.3%, 80.45 and 71.0% respectively. Mean ejection fraction significantly improved to 39±11%, and left ventricular volumes were significantly reduced in the early postoperative period. During a mean of 3.3±2.4 years of follow up, these improvements were still significant in the late period. Of the survivors, 90% were in NYHA functional class I or II. Conclusion: LVR can be performed with a low operative mortality and provide satisfactory long-term survival by restoring the dilated left ventricle and improving systolic function.