Left ventricular reconstruction brings benefit for patients with ischemic cardiomyopathy.
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.


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).


CONCLUSIONS
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.
Aguiar Ribeiro
Gustavo C
GC
Department of Cardiothoracic Surgery, Clinic of Cardio-Surgery at Campinas, Brazil.
Antoniali
Fernando
F
Lopes
Mauricio M
MM
Costa
Cledicyon Eloy
CE
Albuquerque
Ana N
AN
Franchini
Kleber G
KG
D000368:Aged; D009202:Cardiomyopathies / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D001026:Coronary Artery Bypass; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D017202:Myocardial Ischemia / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D055502:Secondary Prevention; D013318:Stroke Volume