Treatment of extensive ischemic cardiomyopathy: quality of life following two different surgical strategies.
OBJECTIVE
To review outcomes and quality of life following two surgical strategies for severe left ventricular dysfunction due to ischemic dilated cardiomyopathy.


METHODS
Hospital and follow-up records of 111 patients with extensive ischemic cardiomyopathy (mean age 57.3+/-8.4) referring to our institution between January 1996 and December 2003 were reviewed. Group A included 42 patients (mean age 62.4+/-7.9) with morphological and functional cardiac parameters allowing for ventricular restoration (including endoventricular circular patch plasty, coronary artery by-pass grafting, and, when needed, mitral surgery). Group B included 69 patients (mean age 54.3+/-7.2), undergoing cardiac transplantation. Hospital mortality, treatment-related late mortality, incidence of cardiac events, freedom from cardiac failure, freedom from hospital re-admission, functional recovery at follow-up (3075.2pts/months; 100% complete) and quality of life (WHOQOL test) were assessed.


RESULTS
Hospital mortality was 19% in group A and 8.7% in group B (P=0.143). No treatment-related late deaths were observed in group A, while six deaths (9.5%) occurred in group B (P=0.063). Incidence of cardiac events was comparable. At 60 months, freedom from cardiac failure was 93.5+/-0.04 and 86.2+/-0.05%, respectively (P=0.23), freedom from hospital re-admission was 93.5+/-0.04 and 61.3+/-0.07% (P=0.002). Exertion dyspnea was present in 40% patients in group A versus 13% in group B (P=0.006). WHOQOL test showed a satisfying quality of life in both groups, although patients undergoing restoration reached higher scores in the psychological and social domains.


CONCLUSIONS
Selected patients with ischemic cardiomyopathy, potentially eligible for transplantation, can be managed by ventricular restoration. In those patients post-operative quality of life is satisfactory, with comparable survival and low risk of re-hospitalization.
Cotrufo
Maurizio
M
Department of Cardiothoracic Sciences, Second University of Naples, Palazzo d'Anna, Via Posillipo 9, 80123 Naples, Italy. maurizio.cotrufo@unina2.it
Romano
GianPaolo
G
De Santo
Luca S
LS
Della Corte
Alessandro
A
Amarelli
Cristiano
C
Cafarella
Giuseppe
G
Maiello
Ciro
C
Scardone
Michelangelo
M
D000328:Adult; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000534:rehabilitation / Q000601:surgery*; D001026:Coronary Artery Bypass; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000517:prevention & control; D016027:Heart Transplantation / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D010359:Patient Readmission; D011788:Quality of Life; D020127:Recovery of Function; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000601:surgery