Surgical Ventricular Restoration: Long-Term Results in Ventricular Remodeling and Risk of Arrhythmias

Abstract

Background: Surgical ventricular reconstruction (SVR) is performed in patients with post-infarction left ventricular remodeling with the aim of reducing ventricular volumes through the exclusion of most of the scarred tissue and to reduce the incidence of inducible ventricular tachycardia. It is not known whether SVR without concomitant anti-arrhythmic surgical procedures is sufficient for the prevention of late arrhythmias or sudden death. Methods: Patients who underwent SVR at our center from January 2008 to February 2021 were included in the study. All patients had complete clinical and echocardiographic evaluations before surgery, after surgery and at follow up. Results: Overall, 55 patients were included (mean age 61.5 ± 10 years), 45 male (82%). One patient died intraoperatively due to a massive thrombus embolization from the aneurysmal cardiac apex to the coronary ostia. Complete bypass grafting was first performed when indicated in 28 patients (51%); concomitant mitral valve treatment was performed in 5 patients (9%). A total of 19 patients underwent rescue percutaneous coronary intervention (35%). An implantable cardioverter-defibrillator (ICD) was implanted in 13 patients (24%) in the postoperative period (almost 3 months post-op). All surviving patients underwent follow-up (mean 8.5 ± 4.5 years) with complete clinical and echocardiographic examination. The Cox regression model revealed that, after accounting for confounding factors such as sex, age, smoking, hypertension, previous stroke, diabetes, ICD implantation does not significantly improve patient survival. However, a univariate analysis comparing total mortality and sudden death in patients with vs without ICD showed a significant difference. Conclusions: SVR is effective in improving patient symptoms and ventricular function. However, as this technique does not involve ablative treatments, the risk of sudden death remains high and patients should undergo electrophysiological re-evaluation for preventive ICD implantation.