Left Ventricular Reconstruction Brings Benefit for Patients With Ischemic Cardiomyopathy

Abstract

Background Optimal treatment strategies for some patients with ischemic cardiomyopathy can be unclear. We compared the outcome for patients treated with revascularization only or with additional ventricular reconstruction. Methods and Results We compared 74 consecutive patients with an ejection fraction <35% and a left end-systolic volume index >80 mL/m 2. All patients underwent revasularization but some received only revascularization (group 1) and some were randomized into a group that received additional ventricular reconstruction (group 2). Preoperative and postoperative ejection fraction, end-systolic volume, mitral regurgitation, mortality, heart failure (HF) symptoms, and recurrence were compared between groups. There was 1 postoperative death in group 2 ( P =. 58). Preoperative ejection fraction between the groups was similar ( P =. 19) but it differed significantly postoperatively ( P < .001). HF class (New York Heart Association) decreased more in group 2 (group 2, 2.3 ± 0.4 versus group 1, 1.4 ± 0.4; P < .001). Incidence of HF recurrence and rehospitalization was significantly less in group 2 ( P = .028). The postoperative development of higher-grade mitral regurgitation was greater in group 1 (147 ± 32 mL/m 2 versus 119 ± 25 mL/m 2, P = .024). Conclusion The outcome at midterm of coronary artery surgery alone in patients with a preoperative large left ventricle was inferior compared with the outcome achieved with additional ventricular restoration.