title: Volume reduction rate by surgical ventricular restoration determines late outcome in ischaemic cardiomyopathy.
abstract: OBJECTIVE
  Surgical 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.
  
  
  RESULTS
  Between 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/m(2) (range 92-310). 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/m(2) (Group-S) in 54 patients, 90-120 mL/m(2) (Group-M) in 16, and >120 mL/m(2) (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).
  
  
  CONCLUSIONS
  SVR is most effective when a >33% volume reduction rate achieves an ESVI of < 90 mL/m(2). No long-term benefits occur when SVR induces an LV volume reduction of < 15% leaving a residual ESVI >90 mL/m(2). This database contradicts the STICH trial findings.
authors.affiliation: Division of Cardiovascular Surgery, Hayama Heart Center, Hayama, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Isomura
authors.forename: Joji
authors.initials: J
authors.lastname: Hoshino
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Fukada
authors.forename: Aki
authors.initials: A
authors.lastname: Kitamura
authors.forename: Shintaro
authors.initials: S
authors.lastname: Katahira
authors.forename: Taichi
authors.initials: T
authors.lastname: Kondo
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Iwasaki
authors.forename: Gerald
authors.initials: G
authors.lastname: Buckberg
mesh_terms: D000368:Aged; D002302:Cardiac Output / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome