Impact of Surgical Ventricular Restoration on Cardiac Function, Ischaemic Mitral Regurgitation and Long-term Survival

Abstract

Objectives: Surgical ventricular restoration in patients with coronary artery disease, post-infarction left ventricular aneurysm or ischaemic dilated cardiomyopathy, is a viable treatment option. Conflicting data exist in published literature as to the utility of this technique. We aimed to evaluate the seven-year clinical experience of this procedure in our institution. Methods: From January 2003 to 2010, surgical ventricular restoration was performed in 86 patients (male:female, 2.3:1), mean age 64.5 (44-84) years. All patients presented with angina, heart failure and/or ventricular tachycardia. Post-infarction left ventricular aneurysm was present in all patients and ischaemic dilated cardiomyopathy with a large akinetic left ventricle in 10/86 (11.6%). The preoperative left ventricular ejection fraction (LVEF) was 33.1+10%. Multi-vessel disease was present in 80/86 (93%) patients. Mitral regurgitation more than grade 2 was found in 10/86 (11.6%). The mean logistic EuroSCORE was 13.8+2.9%. Results: All patients underwent endoventricular or circular patch repair. Ninety-four percent had concomitant coronary revascularization (median of two grafts); 5% had mitral valve repair. Postoperative stroke occurred in one patient. In-hospital mortality was 4/86 (4.6%). All-cause cardiovascular mortality at five years was 7/86 (8.1%). Actuarial survival at 1, 2 and 5 years was 90.6%, 87.9% and 79.1% respectively. Echocardiographic data demonstrated a one-year reduction in mean left ventricular end diastolic and left atrial dimensions. Ejection fraction improved over the first postoperative year from 33.1+10% to 45+15%. Conclusions: Left ventricular reconstruction is a reproducible surgical option for treatment of post-infarction left ventricular aneurysm. Early and longterm results are good in terms of survival and better when compared to ventricular resynchronization therapy and medical management.