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J Thorac Cardiovasc Surg 2008;135:1054-1060
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Acute hemodynamic and functional effects of surgical ventricular restoration and heart transplantation in patients with ischemic dilated cardiomyopathy

^a Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
^b Department of Cardiovascular Surgery and Transplants, Monaldi Hospital, Naples, Italy
^c Department of Cardiac Surgery, University of Foggia, Foggia, Italy

Received for publication May 30, 2007; revisions received September 13, 2007; accepted for publication September 24, 2007.

^_* Address for reprints: Luca Salvatore De Santo, MD, Viale Colli Aminei 491, 80131, Naples, Italy. (Email: luca.desanto{at}ospedalemonaldi.it).

Objectives: Peak oxygen uptake (VO ₂) and ventilatory efficiency have prognostic implications in the population with congestive heart failure. This study evaluated quality-of-life functional capacity after the 2 treatment strategies of surgical ventricular restoration and transplantation for severe left ventricular dysfunction of ischemic cause.

Methods: The 75-patient study population (between 2004 and 2006) with severe heart failure included 35 patients undergoing surgical ventricular restoration (mean age, 62.6 ± 8.7 years), sometimes together with coronary artery bypass grafting or mitral surgery, and 40 cardiac transplant recipients (mean age, 55.6 ± 7.7 years). Preoperative and 6-month postoperative function (peak VO ₂, the anaerobic threshold, and the slope of minute ventilation/carbon dioxide uptake), cardiac catheterization parameters (left and right), and hospital and early outcomes were evaluated.

Results: The 2 groups had comparable baseline functional impairment and experienced similar hospital stay and early outcomes. They also showed similar improvements in left ventricular volume indexes and hemodynamic parameters and sustained significant improvements of median VO ₂, anaerobic threshold, and minute ventilation/carbon dioxide uptake values.

Conclusions: Both surgical strategies resulted in a significant and comparable improvement of functional capacity at the 6-month evaluation. These early studies must be repeated to determine the long-term benefits of surgical ventricular restoration because maximal VO ₂ and ventilatory efficiency lose their prognostic survival role after transplantation.