AimsSurgical ventricular restoration (SVR) effectively reduces left ventricular (LV) volume in ischaemic cardiomyopathy (ICM), but the recent Surgical Treatment of Ischemic Heart Failure (STICH) Trial questions its importance. We report 8-year SVR experience in patients with ICM.Methods and resultsBetween 2000 and 2008, 135 patients underwent SVR for ICM. This report analyses data from 90 patients who underwent accurate pre- and post-operative assessment of LV volumes by left ventriculogram or scintigram. All patients also had echocardiograms. Pre-operative LV end-systolic volume index (ESVI) was 123.5 ± 53.2 mL/m2 (range 92310). Overall, 63 patients were in NHYA class III and 27 were in class IV. The SVR procedure was endoventricular circular patch plasty in 33 patients, septal-anterior ventricular exclusion in 43, and 14 patients had posterior exclusion. Coronary artery bypass grafting was performed in 78 patients (87) and 50 underwent mitral procedures. Eighteen follow-up late deaths occurred owing to chronic heart failure (n 12) and sudden death (n 6). Post-operative ESVI was <90 mL/m2 (Group-S) in 54 patients, 90120 mL/m2 (Group-M) in 16, and >120 mL/m2 (Group-L) in 20 patients. The 8-year survival rate was 82.4 in group-S following a >33 LV volume reduction. In contrast, in Group-M and Group-L, the volume reduction was ∼15, and 100 of patients died within 7 years following the SVR procedure (or 0 8-year survival).ConclusionsSVR is most effective when a >33 volume reduction rate achieves an ESVI of <90mL/m2. No long-term benefits occur when SVR induces an LV volume reduction of <15 leaving a residual ESVI >90 mL/m2. This database contradicts the STICH trial findings.
- Ischaemic cardiomyopathy
- Surgical ventricular restoration