Reconstructive Surgery for an Akinetic Anterior Ventricular Wall in Ischemic Cardiomyopathy
Masataka Yoda, MD, PhD,1,2 Gero Tenderich, MD, PhD,1 Armin Zittermann, MD, PhD,1 Sebastian Schulte-Eistrup, MD,1 Michaele Al-Deili, MD,1 Reiner Körfer, MD, PhD,1 and Kazutomo Minami, MD, PhD1,3
Background: The purpose of this prospective study is to analyze the postoperative outcome after only left ventricular reconstruction (LVR) versus LVR combined with coronary artery bypass grafting (CABG) and/or mitral valve (MV) procedure in ischemic cardiomyopathy (ICM) as a result of an akinetic anterior ventricular wall.
Methods and Results: Nineteen patients underwent only LVR, and 37 underwent a concomitant LVR procedure. In both groups, New York Heart Association (NYHA) classification improved significantly from 3.5 ± 0.6 to 2.2 ± 0.5 (LVR group) and 3.4 ± 0.7 to 2.5 ± 0.5 (combined LVR group). Ejection fraction improved significantly from 25.1 ± 3.2 to 35.3 ± 4.5% in the LVR group and 28.1 ± 2.2 to 37.6 ± 5.5% in the combined LVR group. Cardiac index improved significantly from 1.8 ± 0.6 to 2.3 ± 0.5 l/min/m2 in the LVR group and 1.6 ± 0.4 to 2.2 ± 0.6 l/min/m2 in the combined LVR group. An additional concomitant procedure increased the mortality rate only slightly. The overall 1- and 5-year actuarial survival rates were 90% and 75% in the LVR group and 80% and 70% in the combined LVR group.
Conclusions: The LVR for akinetic ventricular wall shows very satisfactory early and long-term results. The LVR, with or without concomitant procedures, has considerable benefits for operative therapy. (Ann Thorac Cardiovasc Surg 2009; 15: 227-232)
Key words: ischemic cardiomyopathy, left ventricular reconstruction, akinetic anterior ventricular wall
1Department of Thoracic and Cardiovascular Surgery, Heart Center North-Rhine-Westphalia, Ruhr-University of Bochum, Bochum, Germany; 2Department of Cardiovascular Surgery, The Cardiovascular Institute Hospital, Tokyo; and 3Department of Thoracic and Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
Received April 3, 2008; accepted for publication June 30, 2008
Address reprint requests to Masataka Yoda, MD, PhD: Department of Cardiovascular Surgery, The Cardiovascular Institute Hospital, 7–3–10 Roppongi, Minato-ku, Tokyo 106–0032, Japan.