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38. Surgical Ventricular Remodeling For Multi-Territory Myocardial Infarction: Defining A New Patient Population
Nishant D Patel, Christopher J Barreiro, Michele Waldron, Torin P Fitton, Jason A Williams, Pramod Bonde, John V Conte; Baltimore, MD

Objectives:
Surgical ventricular remodeling (SVR) is an established treatment for ischemic cardiomyopathy due to anterior wall myocardial infarction (MI). Due to limited medical and surgical options, our group expanded the criteria for SVR to include patients with multi-territory MI who have historically been considered poor risk candidates. We present the first series of patients with multi-territory MI undergoing SVR and identify a new patient population who benefit from this procedure.

Methods:
Data were analyzed for 52 consecutive SVR patients from 1/2002 to 6/2004. Three left ventricular territories were defined according to coronary vasculature: Antero-apico-septal (left anterior descending), lateral (circumflex), and inferior (posterior descending). Multi-territory MI (n=32) was assessed using cardiac catheterization, echocardiography (ECHO), magnetic resonance imaging (MRI), and operative findings. Follow-up was 100% (32/32) complete.

Results:
Multi-territory MI was identified in 61.5% (32/52) of SVR patients. Mean age was 61.4+11.2 years (range 40-81) with a M:F of 28:4. 62.5% (20/32) of multi-territory MI patients had evidence of MI in all three territories. Four patients had concomitant mitral valve repair. In-hospital mortality was 9.4% (3/32). Imaging revealed that SVR improved LV volumes and ejection fraction in multi-territory MI patients (Table 1). 77.8% (21/27) of multi-territory MI patients in preoperative New York Heart Association class III/IV improved to class I/II at follow-up (p<0.01). Survival of multi-territory MI patients was comparable to patients with single-territory (anterior) MI (n=20) (Figure 1).

Conclusions:
We have identified a new patient population for SVR. Our early results show that SVR improves LV function and quality of life for these patients. With the limited medical and surgical options for end-stage ischemic cardiomyopathy, SVR should be considered for patients with multi-territory MI.

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