Safety and effectiveness of surgical ventricular reconstruction after transmural anterior myocardial infarction in a single-centre experience

OBJECTIVE:Surgical ventricular restoration is used to treat patients affected by left ventricular dilation after anterior transmural necrosis. Surgical reconstruction aims to reduce left ventricular volume and to create a more elliptical shape by excluding scar region. The purpose of the present study was to assess how this surgical procedure affects survival and hospitalization for cardiac causes, as well as symptom relief. METHODS:Between January 2004 and July 2009, 28 patients underwent surgical ventricular reconstruction with or without coronary artery bypass grafting and with or without mitral valve repair or replacement. Inclusion criteria were ejection fraction of 40% or less, end-diastolic volume index of 100ml/m2 or more, history of anterior STEMI with wall motion dysfunction that was amenable to surgical ventricular restoration, New York Heart Association functional class II, III or IV and a normal right ventricle. Early and late mortality, hospitalization for cardiac causes and symptom improvement were considered for the analysis. RESULTS:Median follow up was 33 months. Thirty-day mortality was 10.7% (3/28), while no patient was found dead at follow up. Global systolic function improved postoperatively. Ejection fraction increased from 28.7±6.6% to 36.5±9.0% at discharge (P=0.014). End-diastolic left ventricular volume decreased from 197.1±70.8 ml to 127±42.7 ml at discharge (P=0.008). Preliminary echocardiographic follow up data showed ejection fraction 39.3±9.4% and end-diastolic left ventricular volume 141.5±38.8 ml. Five patients (17.8%) were readmitted to hospital due to cardiac causes and one of them eventually received a heart transplantation for end-stage congestive heart failure. New York Heart Association functional class improved from 3.1±0.5 to 2.2±0.8 (P=0.001), being 75% of the surviving patients in functional class I or II. CONCLUSIONS:In our experience, surgical ventricular restoration improves ventricular function and functional status, with an acceptable operative mortality in high-risk patients, good long-term relief from cardiac symptoms and freedom from further readmission to hospital due to cardiac causes.