Benefit of the Left Ventricular Repair During Coronary Revascularization in Dilated Ischemic Cardiomyopathy
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- Category: Vol. 77, June 2009
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Benefit of the Left Ventricular Repair During Coronary Revascularization in Dilated Ischemic Cardiomyopathy,WALID SHAKER, MOSAAD A. ABOUALNASR and HAZEM M. ZAKI
Abstract
Objectives: Studying the outcome of the addition of the left surgical ventricular restoration (SVR) to CABG compared to isolated CABG after a time interval from 6 to 24 months from the initial operation. We adopted in this research, the DOR repair using the Endoventricular circular patch to restore the ventricular shape after excision of the scar tissues.
Methods: We collected from our database 32 coronary patients operated between 2005 and 2008. These patients were presented with poor LV function, EF <30%, dilated LV di-mension with a LV end diastolic diameter (LVedD) >6 cm. All the 32 patients had left heart catheterization, left ventri-clography, nuclear scanning for viability and function. TEE was done to evaluate the wall motion, function, degree of mitral regurgitation, and LV dimensions including LVesD and LVedD. 14 of these patients (group A) had DOR repair during the coronary revascularization. 18 patients (group B) had only coronary revascularization without DOR repair and represent the control group. The patients in the 2 groups were assessed in a time interval ranging between 6 and 24 months [average 15 months] from the initial operation. Mortality, morbidity and symptoms of heart failure were compared in both groups. LV function, LV geometry were assessed by TEE and Cine MRI. Results related to the findings were compared statistically with a p value <0.05 considered to be significant. All values were calculated as mean ± SD.
Results: The operative data showed no difference between the 2 groups. The average number of grafts was 3±1 and 3± 0.8 respectively in group A and B. Mitral repair was done in 6 cases in group A and 4 cases in group B. No operative mortality in both groups. The post operative IABP was used in 2 patients in group A and were started before surgery to stabilize the patient hemodynamic. In group B, 4 patients needed IABP for post operative cardiac support. The post operative data collection was done over a time interval from 6 to 24 months after the initial operation [average 15 months]. these data showed significant improvement of the LV function and reduction of the LVedV in group A with the DOR repair. Only 1/14, (7%) patient had signs of congestive heart failure compared to 6/18, (33.3%) patients in group B who received only coronary revascularization. Rehospitalisation was needed for 2/18, (11.1%) patients in group B for signs of heart failure. Persistent moderate mitral regurgitation occurred in 2/18, (11%) cases in group B. One case of late mortality, 18 months after the initial surgery occurred in group B. The Cause was not identified.
Conclusion: DOR ventricular repair associated with coronary revascularisation in patient with dilated ischemic cardiomyopathy could improve the ventricular function and decrease morbidity, mortality, incidence of heart failure and rehospitalisation in this high risk group of patient.