Surgical ventricular remodeling for dilated ischemic cardiomyopathy : preliminary results

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Vandenplas Guy, Bove Thierry, Van Bellegem Yves, Van Overbeke Hans, Caes Frank, François Katrien, Van Nooten Guido

 

UZ Gent, Gent

Objectives: To report on the early experience with surgical ventricular repair (SVR) of dilated ischemic cardiomyopathy as adjunct heart failure treatment

Methods: Since april 2005, 15 patients underwent SVR with concomitant CABG and mitral valve surgery. The indication for SVR was primarily based on LV volume determination. Retrospective analysis was focused on clinical and operative data, and short-term echocardiographic assessment of systolic and diastolic left ventricular (LV) performance.

Results: All patients (mean age 68,8 years) were preoperatively in NYHA class III-IV (mean 3,4), presenting an absolute Euroscore of 11,3 , which corresponded to a predicted operative mortality of 26,8 %. In-hospital mortality was 20 % (cardiac-related 7 %). Within a mean follow-up of 17 ± 7 months, survivors improved to NYHA class I-II (mean 1,3), including 2 re-hospitalizations. Echocardiographic evaluation revealed significant increase of LVEF (27,5 % > 41 %; p = 0,001) and fractional shortening (17,7 % > 26,3 %; p = 0,05) and lower wall motion score index (2,23 > 1,83; p = 0,01). The systolic function improvement was already apparent within the first month after surgery. Diastolic LV dysfunction worsened progressively over time, shown by increased E/A ratio (1,2 > 2,4 ; p = 0,06) and E’/A’ ratio (0,64 > 1,19 ; p = 0,02). Regarding the mitral valve, regurgitation decreased from 2,33 to 1,13 (p = 0,04), including 1 recurrent MR grade 3.

Conclusions: Surgical ventricular restoration results in a significant improvement of the systolic LV function, and subsequently to an improved clinical status. However, it entails a time-dependent impairement of the diastolic LV function. Further study is required to define the additional value of SVR in comparison with coronary revascularization and mitral valve repair alone for dilated ischemic cardiomyopathy.