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(Circulation. 2004;110:II-169 – II-173.)
© 2004 American Heart Association, Inc.

Cardiac Transplantation and Surgery for Congestive Heart Failure

Safety and Efficacy of Surgical Ventricular Restoration in Unstable Patients With Recent Anterior Myocardial Infarction

Marisa Di Donato, MD; Alessandro Frigiola, MD; Melika Benhamouda, MD; Lorenzo Menicanti, MD

From San Donato Hospital (A.F., M.B., L.M.), San Donato Milanese, Milano, Italy; and the Department of Critical Care Medicine (M.D.D.), University of Florence, Florence, Italy.

Correspondence to Marisa Di Donato, MD, Istituto Policlinico San Donato, 20097 San Donato Milanese (Milano), Italy. E-mail marad{at}tin.it

Background— The effects and efficacy of surgical ventricular restoration (SVR) in ischemic cardiomiopathy caused by chronic anterior myocardial infarction (MI) are well established. Normally, SVR is delayed at least 3 months after MI to allow the healing of infarcted tissue. Some patients have instability <30days after anterior MI, with increased risk for morbidity and mortality.

Objectives— This study tests the safety and efficacy of SVR in the setting of subacute complicated anterior MI, in terms of early and late outcome.

Methods and Results— 74 patients (62±10 years) were submitted to SVR at 30 days after anterior MI for clinical instability and were retrospectively selected from a series of 430 patients undergoing SVR at our center, between 1998 and 2001. The surgical indications included: angina (60%); New York Heart Association class 4 (62%); clinical signs of heart failure (18%); life-threatening arrhythmias (12%); and cardiogenic shock in 4% (or 3) patients. Follow-up is available for 93% of patients. All patients had coronary artery bypass grafting (CABG) (3.1±1.2) with internal mammary artery (IMA) utilization. An endoventricular patch was used in 17 patients (23%); direct ventriculotomy closure was used in the remaining patients. Operative mortality was 5.4% (4/74). Hemodynamic parameters improved significantly in patients with dilated hearts and reduced ejection fraction. Mitral regurgitation that resulted was significantly reduced. Survival at 3 years was 87% in the overall population and 85% in patients 70 years or older.

Conclusions— This study reports the largest series of patients with complicated, recent anterior MI treated with SVR. The results show that SVR is feasible, has acceptable in-hospital mortality, and has good early and late outcome. Further experience is needed to establish whether SVR, which excludes the infarcted region, can prevent the long-term adverse remodeling of LV dilated hearts after anterior infarction.

Key Words: myocardial infarction • heart failure • remodeling • cardiovascular surgery