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Eur J Cardiothorac Surg 2006;30:753-759
© 2006 Elsevier Science NL

The impact of left ventricular reconstruction on survival in patients with ischemic cardiomyopathy

^a Department of Cardiovascular Medicine, Cleveland Clinic, Desk 25, 9500 Euclid Avenue, Cleveland, OH 44195, United States
^b Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, United States
^c George and Linda Kaufman Center for Heart Failure, Cleveland, OH, United States
^d Department of Cardiac Surgery, Northwestern University, Chicago, IL, United States

Received 14 June 2006; received in revised form 17 July 2006; accepted 19 July 2006.

^_* Corresponding author. Tel.: +1 216 444 2268; fax: +1 216 444 7155. (Email: starlir{at}ccf.org).

Objective: Left ventricular reconstruction (LVR) is performed to improve the morphologic structure and function of the heart in patients with heart failure. This procedure has been performed at the Cleveland Clinic Foundation since 1997. We assessed mortality, functional status, and predictors of outcome in these patients. Methods: Data were extracted from multiple prospectively acquired datasets on demographic, clinical, and operative details of 220 consecutive patients who underwent LVR between July 1997 and July 2003, where the indication for surgery was heart failure (of whom 66% had New York Heart Association (NYHA) functional class III or IV symptoms). Mortality, functional status, and postoperative complications were ascertained by reference to the clinical record, social security death index, and by phone contact. Mean preoperative left ventricular ejection fraction (LVEF) was 21.5 ± 7.3% and mean left ventricular end-diastolic diameter was 6.4 ± 1.0 cm. The mean age was 61.4 ± 9.0 years and 80% were male. The majority (86%) of patients underwent concomitant coronary artery bypass grafting and 49% underwent mitral valve surgery. Results: Thirty-day mortality was 1% and survival at 1, 3, and 5 years was 92%, 90%, and 80%, respectively. Of the survivors for whom data on NYHA functional class were available, 85% were in NYHA functional class I or II. Mortality was predicted by reduced preoperative ejection fraction <20% (unadjusted hazard ratio 1.53, p = 0.02), body mass index 24 kg/m² (unadjusted hazard ratio 1.69, p = 0.01), QRS duration 130 ms (unadjusted hazard ratio 1.66, p = 0.01) and the requirement for renal replacement therapy postoperatively (unadjusted hazard ratio 3.85, p < 0.01). Mean LVEF improved to 24.7 ± 8.86% (p < 0.01) and left ventricular volumes were also significantly reduced. Conclusions: In selected patients with heart failure, LVR, in conjunction with revascularization and valve surgery, is associated with excellent survival, improved symptoms, and improved LVEF and left ventricular dimensions.

Key Words: Heart failure • Left ventricular reconstruction • Ischemic cardiomyopathy

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