LEFT VENTRICULAR RECONSTRUCTION IN CASES OF ISCHEMIC DILATED CARDIOMYOPATHY : LONG-TERM (13 YEARS) RESULTS
GUGLIELMO STEFANELLI1, FABRIZIO PIRRO1, PAOLO GIOVANARDI2, ALINA OLARU1, DAVIDE TREVISAN1, MARCO MELI1.
1Hesperia Hospital, modena, Italy, 2Ospedale Policlinico, modena, Italy.
OBJECTIVE: Aim of the study was to analyze the long term results (13 years) after left ventricular restoration (SVR) in cases of dilated ischemic cardiomyopathy, and to emphasize the importance of reshaping the cavity in addition to reducing the left ventricular volume.
METHODS: Between March 2003 and September, 2014, 60 patients affected by ischemic dilated cardiomyopathy received a SVR at our institution, along with surgical myocardial revascularization.The STICH trial criteria have been used as indication to SVR.The patients underwent SVR using a typical DOR operation, or, more recently adopting a different surgical technique, with the aim of reshaping the left ventricle also at the dilated equatorial level. A mean reduction of left ventricular and systolic volume greater than 50% was achieved in all cases. Follow-up time ranged between 6 months and 13 years ( mean 8,4 years )
RESULTS: Total early-in hospital mortality was 3,4% , (0% in the last 31 cases). Reduction of LVED diameter, improvement of EF and NYHA class after surgery and at last follow-up were statistically significant (p<0,05).Residual mitral incompetence. at discharge was absent in 34 patients ( 59,6%) , mild in 2 ( 3,5% ). Late mortality was 44% ( 25 pts ) , with a cardiac mortality of 20%. Freedom from rehospitalization for heart failure was 87% for the entire group of pts.
CONCLUSIONS: Patients affected by ischemic dilative cardiomyopathy, in our experience, have a satisfactory short and intermediate-time outcome after SVR , particularly if accomplished by using a surgical protocol addressing both the volume and the shape of the left ventricle.
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