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Eur J Cardiothorac Surg 2005;27:481-487
© 2005 Elsevier Science NL

Treatment of extensive ischemic cardiomyopathy: quality of life following two different surgical strategies

^a Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
^b Department of Cardiovascular Surgery and Transplants, Monaldi Hospital, Naples, Italy

Received 17 September 2004; received in revised form 9 December 2004; accepted 13 December 2004.

^* Corresponding author. Address: University of Naples, Palazzo D'Anna, Via Posillipo 9, 80123 Naples, Italy. Tel.:+ 39 081 769 1893; fax: +39 081 546 4594. (E-mail: maurizio.cotrufo{at}unina2.it).

Objective: To review outcomes and quality of life following two surgical strategies for severe left ventricular dysfunction due to ischemic dilated cardiomyopathy. Methods: Hospital and follow-up records of 111 patients with extensive ischemic cardiomyopathy (mean age 57.3±8.4) referring to our institution between January 1996 and December 2003 were reviewed. Group A included 42 patients (mean age 62.4±7.9) with morphological and functional cardiac parameters allowing for ventricular restoration (including endoventricular circular patch plasty, coronary artery by-pass grafting, and, when needed, mitral surgery). Group B included 69 patients (mean age 54.3±7.2), undergoing cardiac transplantation. Hospital mortality, treatment-related late mortality, incidence of cardiac events, freedom from cardiac failure, freedom from hospital re-admission, functional recovery at follow-up (3075.2pts/months; 100% complete) and quality of life (WHOQOL test) were assessed. Results: Hospital mortality was 19% in group A and 8.7% in group B (P=0.143). No treatment-related late deaths were observed in group A, while six deaths (9.5%) occurred in group B (P=0.063). Incidence of cardiac events was comparable. At 60 months, freedom from cardiac failure was 93.5±0.04 and 86.2±0.05%, respectively (P=0.23), freedom from hospital re-admission was 93.5±0.04 and 61.3±0.07% (P=0.002). Exertion dyspnea was present in 40% patients in group A versus 13% in group B (P=0.006). WHOQOL test showed a satisfying quality of life in both groups, although patients undergoing restoration reached higher scores in the psychological and social domains. Conclusions: Selected patients with ischemic cardiomyopathy, potentially eligible for transplantation, can be managed by ventricular restoration. In those patients post-operative quality of life is satisfactory, with comparable survival and low risk of re-hospitalization.

Key Words: Ischemic cardiomyopathy • Ventricular restoration • Heart transplantation • Quality of life

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