Ventricular reconstruction surgery: an alternative therapy in advanced heart failure

Abstract

Surgical ventricular reconstruction is a specific procedure for the management of heart failure with left ventricular remodeling caused by coronary artery disease. Heart transplant is an option when nothing else is appropriate. However, limited donors, presence of comorbidities or advanced age, restrict this therapy for few patients. In this scenario surgical ventricular reconstruction with CABG is an alternative treatment for patients with coronary anatomy suitable for such surgery, left ventricular ejection fraction of 35% or less, ventricular volumes increase and extended akinesia or dyskinesia. Objectives: To evaluate hospital mortality,  changes in ventricular volumes, ejection fraction and long-term follow-up of quality of life and survival in those patients who underwent CABG with surgical ventricular reconstruction. Methods: 45 patients underwent CABG with surgical ventricular reconstruction, selecting those with left ventricular ejection fraction of 35% or less, ventricular enlargement (defined by LVESV >60 ml/m2) and symptoms in functional class NYHA III-IV. The mean age was 58+/- 9 years, and 43 of the 45 patients were men, 33% diabetic, with body mass index of 27+/- 4 and 15% had chronic renal insufficiency. Results: Perioperative mortality occurred in 4 patients (8.88%). Preoperative LVESV was 92 (76-102) ml / m2 and postoperatively of 59 (44-68) ml / m2 (p <0.001). Preoperative EF was 25% (18-31) and 37% (30-42) (p = <0.001) after surgery. During the follow-up for 4.2 years (2.4-8.9), 14 patients died (5
of cardiovascular causes). Today out of 27 living patients, 21 have a good and 6 regular quality of life as measured by the Duke Index. One patient underwent heart transplant. Conclusions: Surgical ventricular reconstruction showed an acceptable perioperative mortality with good survival and adequate quality of life in the long-term follow-up. This strategy should be considered as a potential treatment in patients with poor ventricular function refractory to medical treatment as an alternative therapy in case of not being a candidate for heart transplant or as a bridge to heart transplant.