Is surgical ventricular restoration still relevant in ischaemic heart failure treatment? A 20-year follow-up study

OBJECTIVES As new technologies are being developed to treat ischaemic heart failure, the relevance of surgical ventricular restoration (SVR) is unclear. We aimed to determine the long-term surgical and echocardiographic outcomes of SVR up to 20 years postoperatively. METHODS From April 1997 to December 2019, 128 patients with ischaemic heart failure underwent SVR at our institution. Concomitant surgical revascularization was performed wherever possible. The patients were tracked for up to 20 years by correspondence, in outpatient clinics, or through hospitalization, with an echocardiographic evaluation performed when appropriate. RESULTS The average age at the time of surgery was 57 ± 10 years (range: 33–79), and 92% of the patients were male. Anterior-septal aneurysms were observed in 88.9% of the patients, and 11.1% had inferior aneurysms. The medians and interquartile ranges of preoperative left ventricular ejection fraction (LVEF), end-systolic volume index (LVESVI) and end-diastolic volume index (LVEDVI) were 37% [33%, 43%], 60.7 [48.4, 73.3] ml/m2, and 93.9 [79.3, 112.3] ml/m2. The operative mortality rate was 3.1% (4/128). The postoperative LVEF was 46% [43%, 50%], LVESVI 30.4 [26.9, 37.6] ml/m2, and LVEDVI 56.4 [48.4, 67.5] ml/m2. The 5-, 10-, and 20-year survival rates and their 95% confidential intervals were 91.27% (86.46%, 96.34%), 75.76% (67.6%,84.92%) and 20.91% (9.17%,47.66%), respectively. CONCLUSIONS SVR was associated with excellent long-term survival and a significant improvement in left ventricular function. Therefore, it continues to play an important role, even in this new era of treatment for ischaemic heart failure.