JD Aitchison, U Lukowand, Q Lau, SR Large

Papworth Hospital, Cambs, CB3 8RE UK

Aims. To appraise prognostic and functional benefit of this surgery.

Patients with ischaemia, poor LV (mean EF 24(10%) and LV aneurysm from one centre, follow-up of 217 of all 225 patients with surgery between April 1991 and October 1997, many either inappropriate or awaiting cardiac transplantation.

Procedures. Patients underwent coronary revascularisation with linear aneurysmectomy (59%) or Jatene aneurysmorrhaphy (41%), ( endocardial resection (7.8%) with best anti-failure medication postoperatively.

Results (Mean ( sd). No significant differences existed in age (62(9years), sex ratios (males 80%), LVEDP (20(9mmHg), operation type, NYHA (2.7(0.9) or CCS (3.2(0.9) scores between survivors, 30 day and late deaths, but 30 day deaths were significantly more common in diabetics (p<0.001).

Functional Benefit

Preop 19%, postop 94% of patients in CCS chest pain groups 1+2.

Preop 34%, postop 90% of patients in NYHA dyspnoea groups 1+2.

30 day mortality was 9% with 13% annualised mortality thereafter.

Conclusions. Ejection fraction improves and correlates with symptomatic improvement. Mortality risk is significantly reduced when compared with historic controls, e.g. Stevenson et al, 1990, 1-year mortality of 37% with medical management of cardiomyopathy referred for transplant. A prospective, randomised controlled trial of medical management versus LV remodelling and revascularisation for advanced ischaemic cardiomyopathy is required.

Ref: Stevenson et al, Importance of hemodynamic response to therapy in predicting survival with ejection fraction </= 20% secondary to ischaemic or non-ischaemic dilated cardiomyopathy. Am J. Cardiol, 1990;66:1348-1354.