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J Thorac Cardiovasc Surg 1998;116:50-59
© 1998 Mosby, Inc.
Surgery For Adult Cardiovascular Disease |
From the Centre Cardiothoracique de Monaco, Monaco,a and the Department of Cardiology, University of Florence, Florence, Italy.b
Read at the Seventy-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, D.C., May 4-7, 1997.
Received for publication May 12, 1997. Revisions requested July 15, 1997. Accepted for publication March 16, 1998. Address for reprints: Centre Cardiothoracique de Monaco, 11 Bis Av. D'Ostende, 98400 Monaco Cedex.
Background: Many believe that dyskinesia is the only predictor of favorable surgical outcome after large myocardial infarction and that akinetic scars do not recover well in patients with globally depressed ventricular function.
Methods: This study evaluates clinical and hemodynamic results of endoventricular circular patch plasty in patients with either large akinetic scar (n = 51) or large dyskinetic scar (n = 49) and depressed left ventricular function (ejection fraction <30%). Groups were comparable for symptoms, indication for operation, and delay from myocardial infarction. Heart failure was a major indication for operation in both groups. Coronary grafting was performed in 98% of patients: 10 had mitral valve repair or replacement, and 47 patients with preoperative ventricular arrhythmias had cryotherapy. In-hospital mortality was 12% (five patients in the akinetic group [10%] and seven in the dyskinetic group [14%]).
Results: Results showed an early and late improvement in New York Heart Association functional class and ejection fraction (from 23% ± 5% to 31% ± 11% to 40% ± 13% in akinetic patients and from 23% ± 6% to 41% ± 10% to 41% ± 12% in dyskinetic patients). Ventricular tachycardia was reduced significantly in both groups early and late after the operation.
Conclusion: We conclude that in patients with either large akinetic or dyskinetic scar and severe left ventricular dysfunction, endoventricular circular patch plasty associated with coronary grafting and cryotherapy, when indicated, provides surviving patients with significant improvement in cardiac function. This approach can be considered as an alternative to heart transplantation in patients with severe left ventricular dysfunction. (J Thorac Cardiovasc Surg 1998;116:50-9)
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