Surgical Therapy For Ischemic Heart Failure: Global Experience With Surgical Ventricular Restoration From One Single Center
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Objective: surgical ventricular restoration (SVR) for ischemic dilated cardiomyopathy is an emerging effective therapy for pts with heart failure. We describe our global experience in a large series of pts with previous anterior myocardial infarction .
Methods :From June 1989 to June 2005 1030 pts were submitted to SVR for ischemic dilated cardiomyopathy at our institution. 940 (63+/-10years) out of 1030 had previous anterior myocardial infarction and represent our study group (61% in NYHA class III/IV, 62% withResults: 30-days operative cardiac mortality rate was 3.3%(12/357) in the early series (1989-98)and 5.5% (32/583) after 1998; it was 3.9% without mitral repair and 13% with mitral repair. Mitral repair was done in less than 5% in the early phase and in 20%, subsequently. NYHA class improved from 2.8+/-0.8 to 1.6+/-0.6, p 0.000, EF from 27+/-5 to 36+/-7%, p 0.001, EDV and ESV from 216+/-63 to 147+/-43 and 159+/-57 to 94+/-32 ml, respectively p 0.000.
The degree of mitral regurgitation improved from 2.8+/-9 to1.6+/-1.2 p 0.0001. At univariate analysis age, NYHA class, ventricular dimensions, EF and mitral repair resulted significantly associated to operative death; at multivariate analysis mitral repair was the only independent predictor of mortality (RR 6.339, CI 2.201-18.262, p 0.000). Long term survival in a cohort of 478 pts operated between 1997 and 2005 is reported in the figure. Three years survival rate of pts with NYHA class IV is 62%.
Conclusion: This observational study shows that SVR associated to CABG and mitral repair, when needed, improves clinical status, pump function and survival with an acceptable operative risk.The increased mortality observed in the more recent series is due to a higher rate of mitral repair in higher risk patients. 
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