Surgical Ventricular Restoration (SVR) for Ischemic Cardiomyopathy

Objectives: Ischemic cardiomyopathy (ICM) is defined as the end-stage of ischemic heart disease. The treatment for ICM is not only medication or heart transplantation, but also non-transplant surgery including surgical ventricular restoration (SVR). We studied the effectiveness of the SVR for ICM and the possibility of alternative treatment to heart transplantation. Methods: Since May 2000, SVR for ICM were performed in 186 patients. There were 163 men and 23 women with a mean age of 62 ± 10 years old. There were 164 elective operations and 22 emergent operations. In addition to routine echocardiogram, speckle tracking echocardiogram was introduced to detect the lesion of LV since 2005. After cardioplegic arrest, complete coronary revascularization, and/or mitral or tricuspid surgery was performed, followed by SVR of either anteroseptal or posterior exclusion. The patients were followed up by transthoracic echocardiography. Results: The procedures of SVR was endoventricular circular patch plasty (EVCPP) in 66, septal anterior ventricular exclusion (SAVE) in 94, and posterior restoration procedure (PRP) in 26 patients. In addition to SVR, CABG was performed in 159, mitral surgery in 121 (plasty 105, replacement 16), and tricuspid annuloplasty in 48. Perioperative intra-aortic balloon pumping (IABP) was required in 46 and the hospital mortality was 4.3 % in elective and 18% in emergent operation. After the operation, 132 patients (75%) improved their functional class to class I or II. In the late follow-up, there were 17 cardiac deaths (congestive heart failure 11, ventricular arrhythmia 6). After 2005, the eight-year survival rates were 76.2% in elective operation. Conclusions: Our results demonstrated that the eight-year survival rate was equivalent to that after heart transplantation and 71% of the indicated patients for SVR could avoid heart transplantation with relief of their symptoms.