Left ventricular reconstruction concomitant to coronary artery bypass grafting

PURPOSE OF REVIEW: The increase in left ventricular (LV) volume after a myocardial infarction is a component of the remodeling process and it is associated with a poor clinical outcome. Hence, the current management strategy for ischemic LV dysfunction has been aimed to reverse the remodeling process (i.e., reduction of LV volume and improved ejection fraction) by medical and/or device therapy. Surgical left ventricular reconstruction (LVR) has been introduced as an optional therapeutic strategy aimed to reduce LV volumes through the exclusion of the scar tissue, thereby restoring the physiological volume and shape and improving LV function and clinical status. RECENT FINDINGS: Until recently, LVR was being increasingly performed and a large number of reports drawn on various data sets from registries and mainly observational studies have shown that LVR is effective and relatively safe with a favourable 5-year outcome. However, the most recent released results from the Surgical Treatment for Ischemic Heart Failure (STICH) trial, which showed no difference in the occurrence of the primary endpoint between patients treated with coronary artery bypass grafting (CABG) alone or CABG along with LVR, have called into question the additional benefit of the LV surgical reconstruction. SUMMARY: LVR has recently been endorsed by the European Task Force on Myocardial Revascularization to be considered as a surgical option combined with CABG in selected patients affected by ischemic heart failure and LV dysfunction, mainly in centers with a high level of surgical expertise.