VENTRICULAR REMODELING AND REVASCULARIZATION IN SEVERE LEFT-VENTRICULAR DYSFUNCTION

Objective: To evaluate the role of surgical revascularization in the p resence of severe, global impairment of left ventricular function with out discrete aneurysm formation or mitral regurgitation. The high mort ality and morbidity associated with this group, together with the limi ted benefits tend to prompt referral for cardiac transplantation. Meth ods: Fifty-three patients initially referred for transplantation, in a ddition to coronary revascularization, underwent mitral annuloplasty ( group A = 23), free wall remodelling by endoaneurysmorrhaphy (group B = 17) or mitral annuloplasty and free wall reconstruction (group C = 1 3). The mean ages were 59, 56 and 57 years for groups A, B and C, resp ectively. Detailed assessment of pre- and post-operative physical and psychological status were carried out. Results: Followup was for a mea n period of 22-26 months. All patients reported substantial improvemen t in quality of life, both physical and psychological parameters and i n NYHA functional class status. Objective evidence of improvement in e jection fraction was seen in all three groups but especially in group A. There were five early deaths, four were due to inadequate revascula rization due to the poor quality of target vessels. There were three l ate deaths and one patient that required transplantation. Conclusion: We conclude that patients with severe left ventricular dysfunction can be candidates for surgical revascularization and optimization of vent ricular geometry with acceptable mortality. The importance of achievin g complete revascularization is emphasized in this series. (C) 1998 El sevier Science B.V. All rights reserved.