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Ann Thorac Surg 2009;88:708-709. doi:10.1016/j.athoracsur.2009.01.003
© 2009 The Society of Thoracic Surgeons
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Correspondence

Surgical Ventricular Restoration: Who Really Benefits?

Teruya Nakamura, MD

Division of Cardiovascular Surgery, National Hospital Organization, Kure Medical Center, 3-1 Aoyama-Cho, Kure, Hiroshima, 737-0023 Japan

(Email: teruyan{at}kure-nh.go.jp).

To the Editor:

We congratulate the outstanding work of Prucz and colleagues [1], who provided us a very important message on the possibility of surgical ventricular restoration (SVR) as a treatment of congestive heart failure. They described that SVR improved the long-term outcome of patients with ischemic cardiomyopathy, in terms of reduction of re-hospitalization, improvement of New York Heart Association functional class, and the increased number of patients whose ejection fraction improved by 5% or more, although they found no survival benefit.

We agree that SVR, at least to certain patients, can provide excellent symptomatic relief from severe congestive heart failure caused by ischemic cardiomyopathy [2]. Unfortunately, SVR is not always beneficial for patients with the less viable myocardium and severe ventricular remodeling (ie, larger end-systolic volume and lower ejection fraction) [3]. A query arises as a consequence of their cohort selection for comparison (ie, the "SVR-candidates" for whom SVR was not actually eligible for whatever reasons). We need more information on their patient selection, in terms of viability and myocardial reserve analysis, such as magnetic resonance images or dobutamine-challenge echocardiography. Moreover, it is interesting to see the correlation between clinical improvement and viability and completeness of revascularization on the noninfarcted area.

It is well documented that mitral regurgitation affects the long-term outcome of patients with ischemic cardiomyopathy, and mitral valve repair is the common practice in the setting [4]. They performed more mitral operations on SVR (plus coronary artery bypass grafting [CABG] patients) than SVR candidate patients, which suggested that presence of preoperative mitral regurgitation may have affected their decision on SVR or CABG alone. This is especially true for us, as we prefer off-pump coronary bypass on "CABG alone" patients. Also, it would be interesting to know if mitral regurgitation worsened postoperatively on patients who did not improve by SVR plus CABG, and if additional mitral repair could improve the outcome of SVR. Hopefully, the final results of the Surgical Treatment for Ischemic Heart Failure trial would answer the questions.


   References
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 References
 

  1. Prucz RB, Weiss ES, Patel ND, Nwakanma LU, Baumgartner WA, Conte JV. Coronary artery bypass grafting with or without surgical ventricular restoration: a comparison Ann Thorac Surg 2008;86:806-814.[Abstract/Free Full Text]
  2. Menicanti L, Castelvecchio S, Ranucci M, et al. Surgical therapy for ischemic heart failure: single-center experience with surgical anterior ventricular restoration J Thorac Cardiovasc Surg 2007;134433-141.
  3. Lloyd SG, Buckberg GD, RESTORE Group Use of cardiac magnetic resonance imaging in surgical ventricular restoration Eur J Cardiothorac Surg 2006;29(Suppl 1)S216-124.
  4. Vaskelyte J, Stoskute N, Ereminiene E, Zaliunas R, Benetis R, Sirvinskas E. The impact of unrepaired versus repaired mitral regurgitation on functional status of patients with ischemic cardiomyopathy at one year after coronary artery bypass grafting J Heart Valve Dis 2006;15747-154.

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Roni Prucz, Eric S. Weiss, and John V. Conte
Ann. Thorac. Surg. 2009 88: 709. [Extract] [Full Text] [PDF]



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R. Prucz, E. S. Weiss, and J. V. Conte
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Ann. Thorac. Surg., August 1, 2009; 88(2): 709 - 709.
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