Volume reduction rate by surgical ventricular restoration determines late outcome in ischaemic cardiomyopathy

Tadashi Isomura, Joji Hoshino, Yasuhisa Fukada, Aki Kitamura, Shintaro Katahira, Taichi Kondo, Tomoaki Iwasaki, Gerald Buckberg

Research output: Contribution to journalArticlepeer-review

34 Citations (Scopus)

Abstract

AimsSurgical ventricular restoration (SVR) effectively reduces left ventricular (LV) volume in ischaemic cardiomyopathy (ICM), but the recent Surgical Treatment of Ischemic Heart Failure (STICH) Trial questions its importance. We report 8-year SVR experience in patients with ICM.Methods and resultsBetween 2000 and 2008, 135 patients underwent SVR for ICM. This report analyses data from 90 patients who underwent accurate pre- and post-operative assessment of LV volumes by left ventriculogram or scintigram. All patients also had echocardiograms. Pre-operative LV end-systolic volume index (ESVI) was 123.5 ± 53.2 mL/m2 (range 92310). Overall, 63 patients were in NHYA class III and 27 were in class IV. The SVR procedure was endoventricular circular patch plasty in 33 patients, septal-anterior ventricular exclusion in 43, and 14 patients had posterior exclusion. Coronary artery bypass grafting was performed in 78 patients (87) and 50 underwent mitral procedures. Eighteen follow-up late deaths occurred owing to chronic heart failure (n 12) and sudden death (n 6). Post-operative ESVI was <90 mL/m2 (Group-S) in 54 patients, 90120 mL/m2 (Group-M) in 16, and >120 mL/m2 (Group-L) in 20 patients. The 8-year survival rate was 82.4 in group-S following a >33 LV volume reduction. In contrast, in Group-M and Group-L, the volume reduction was ∼15, and 100 of patients died within 7 years following the SVR procedure (or 0 8-year survival).ConclusionsSVR is most effective when a >33 volume reduction rate achieves an ESVI of <90mL/m2. No long-term benefits occur when SVR induces an LV volume reduction of <15 leaving a residual ESVI >90 mL/m2. This database contradicts the STICH trial findings.

Original languageEnglish
Pages (from-to)423-431
Number of pages9
JournalEuropean Journal of Heart Failure
Volume13
Issue number4
DOIs
Publication statusPublished - 2011 Apr
Externally publishedYes

Keywords

  • Ischaemic cardiomyopathy
  • Surgical ventricular restoration

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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