Ventricular Reverse Remodeling After Coronary Artery Bypass, Chordal‐Sparing Mitral Valve Replacement, and Tricuspid Valve Repair

Objective This study aimed to evaluate the long‐term efficacy of a standardized triple procedure—coronary artery bypass grafting (CABG), chordal‐sparing mitral valve replacement, and tricuspid annuloplasty—in high‐risk patients with end‐stage ischemic dilated cardiomyopathy (IsDCM) for whom heart transplantation was not an option. Primary endpoints were survival, reverse ventricular remodeling, and functional recovery. Methods We prospectively analyzed 42 consecutive patients (mean age 64.7 ± 9.1 years; 85.7% male) with end‐stage IsDCM. All presented with severe secondary mitral and tricuspid regurgitation, left ventricular ejection fraction (LVEF) < 30% (mean 26.4% ± 3.1%), left ventricular end‐diastolic diameter > 7.0 cm (mean 7.3 ± 0.3 cm), and coaptation depth > 1.0 cm. Mean STS‐predicted mortality risk was 22.0% ± 1.5%, and mean EuroSCORE II was 7.0% ± 1.0%. Results Thirty‐day operative mortality was 2.4% ( n = 1). Significant reverse remodeling occurred: LVEF improved from 26.4% ± 3.1% to 34.6% ± 4.2% ( p < 0.001), and end‐systolic sphericity index decreased from 86.1% to 66.3%. NYHA class improved from 3.5 ± 0.5 to 1.8 ± 0.6 among survivors at 1 year ( p < 0.001). Long‐term survival was 78.5% ± 4.0% at 5 years and 54.8% ± 5.2% at 10 years. Conclusions In high‐risk end‐stage IsDCM patients, CABG with chordal‐sparing mitral valve replacement and tricuspid annuloplasty facilitates substantial reverse remodeling, durable functional improvement, and excellent long‐term survival. This anatomy‐preserving strategy offers a viable alternative to transplantation or destination therapy for selected patients with advanced heart failure.