Left ventriculoplasty for ischemic cardiomyopathy

Objective: In order to treat ischemic cardiomyopathy, which is defined as n on-aneurysmal diffuse akinetic left ventricle with chronic heart failure fo llowing myocardial infarction, the mid-term effect of the endoventricular c ircular patch plasty (EVCPP) was studied. Materials and methods: EVCPP has been performed on 54 patients (46 men and eight women with a mean age of 61 years) during 4 years from March 1997 to December 2000. Thirty-two patient s (59%) were NYHA class III and 22 patients (41%) were class IV. Nine patie nts (17%) had mild angina pectoris before the operation but others had no c hest pain. Single, double, triple, and left main disease were noted in six, 13, 32, and three patients, respectively. Mean left ventricular ejection f raction was 23.3 +/- 6.3% (6-30%). Coronary artery bypass grafting was conc omitantly undergone by 51 patients (94%) and mitral valve reconstruction wa s done on 19 patients (35%). Results: Two patients (3.7%) needed an intra-a ortic balloon pump to wean from cardiopulmonary bypass. Seven patients (12. 9%) died in the hospital. Among them, two patients (4.4%) out of 45 patient s who underwent elective operation died of stroke and heart failure. Five p atients (55.5%) out of nine patients who required emergency operation died of heart failure and multiorgan failure. Late death occurred in six patient s (11.1%) due to arrhythmia and heart failure in each of three patients. Ou t of 41 survivors, 38 patients returned to NYHA class I or II and three pat ients to class Ill. Out of 50 patients who underwent left ventricular study before and after operation, ejection fraction increased from 22.8 +/- 6.6 to 36.2 +/- 8.0% and mean left ventricular end-diastolic volume and left ve ntricular end-systolic volume indices reduced from 152.8 +/- 24.6 to 105.0 +/- 36.5 and from 113.6 +/- 45.7 to 66.4 +/- 28.4 ml/m(2), respectively. Me an pulmonary wedge pressure decreased from 19.1 +/- 8.8 to 14.9 +/- 6.8 mmH g, One-, 2-, and 3-year actuarial survival rates were 87.9, 82.7 and 77.2%, respectively. Conclusion: Left ventriculoplasty using EVCPP is effective t o exclude the akinetic LV segment, and left ventricular function and clinic al status improve in patients with ischemic cardiomyopathy. (C) 2001 Elsevi er Science B.V. All rights reserved.