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Efficacy of left ventricular restoration with mitral valve surgery for endstage ischemic cardiomyopathy

^a Cardiovascular Surgery, Hayama Heart Center, 1898 Shimoyamaguchi Hayama, Kanagawa, 240-0116, Japan
^b The Cardiovascular Institute, Tokyo, Japan

*Corresponding author: Fax: +81-46-875-3636.

E-mail address: nomura{at}hayamaheart.gr.jp (F. Nomura).

Patients with ischemic cardiomyopathy (ICM) are at an extremely high risk of death and ischemic events. This study aims to evaluate the impact of left ventricular restoration (LVR) and mitral valve surgery on the cardiac and clinical functional status of the patients with ICM. Twenty-six patients (46–80 years, mean: 64 years) with severely dilated heart (left ventricular end-systolic volume index: LVESVI 100 ml/m²) who had coronary artery bypass grafting (2.8±1.3), mitral valve surgery, and LVR were enrolled in this study. Left ventricular end-diastolic volume index and LVESVI significantly decreased (from 169±44 to 130±41 ml/m², P=0.0005, from 120±33 to 89±43 ml/m², P=0.0012). Left ventricular ejection fraction showed no change. MR showed significant improvement (from 2.7±0.6 to 1.0±0.4, P<0.0001) and NYHA functional class showed improvement (from 3.2±0.8 to 1.5±0.9, P<0.0001). A 5-year survival rate was 71.2%. In conclusion, this aggressive approach with LVR aiming to treat end-stage ICM by relief of ischemia, reduction of LV wall tension by decreasing LV volume and stopping mitral leak, is effective for LV volume reduction and improvement of clinical functional status.

Key Words: Ischemic mitral regurgitation; Left ventricular restoration; Ischemic cardiomyopathy; Mitral valve annuloplasty