EFFICACY OF ENDOVENTRICULAR PATCH PLASTY IN LARGE POSTINFARCTION AKINETIC SCAR AND SEVERE LEFT-VENTRICULAR DYSFUNCTION - COMPARISON WITH A SERIES OF LARGE DYSKINETIC SCARS

Background: Many believe that dyskinesia is the only predictor of favo rable surgical outcome after large myocardial infarction and that akin etic scars do not recover well in patients with globally depressed ven tricular function, Methods: This study evaluates clinical and hemodyna mic results of endoventricular circular patch plasty in patients with either large akinetic scar (n = 51) or large dyskinetic scar (n = 49) and depressed left ventricular function (ejection fraction <30%). Grou ps were comparable for symptoms, indication for operation, and delay f rom myocardial infarction. Heart failure was a major indication for op eration in both groups. Coronary grafting was performed in 98% of pati ents: 10 had mitral valve repair or replacement, and 47 patients with preoperative ventricular arrhythmias had cryotherapy. In-hospital mort ality was 12% (five patients in the akinetic group [10%] and seven in the dyskinetic group [14%]), Results: Results showed an early and late improvement in New York Heart Association functional class and ejecti on fraction (from 23% +/- 5% to 31% +/- 11% to 40% +/- 13% in akinetic patients and from 23% +/- 6% to 41% +/- 10% to 41% +/- 12% in dyskine tic patients). Ventricular tachycardia was reduced significantly in bo th groups early and late after the operation. Conclusion: We conclude that in patients with either large akinetic or dyskinetic scar and sev ere left ventricular dysfunction, endoventricular circular patch plast y associated with coronary grafting and cryotherapy, when indicated, p rovides surviving patients with significant improvement in cardiac fun ction, This approach can be considered as an alternative to heart tran splantation in patients with severe left ventricular dysfunction.