Outcomes of surgical ventricular restoration following recent myocardial infarction

Background

Recent myocardial infarction (≤90 days) is generally considered a contraindication to performing surgical ventricular restoration (SVR). Most surgeons prefer myocardial healing and scar formation to occur before undertaking SVR, although no data exist to support this practice. We analyzed outcomes of patients undergoing SVR following recent myocardial infarction (MI) to determine the utility of SVR in these patients.

Methods

Retrospective review analyzed 69 consecutive SVR patients between January 2002 and June 2005 to determine clinical characteristics, operative data, and postoperative outcomes. Magnetic resonance imaging (MRI) and echocardiography were used to assess cardiac function.

Results

Twenty-two patients (32%) sustained a recent MI in our series. Mean age at operation was 63.5 years, with a M:F of 20:2. Preoperatively all patients carried a diagnosis of congestive heart failure and were classified as New York Heart Association (NYHA) class III or IV. Six patients (27%) required perioperative intra-aortic balloon pump (IABP) support. There was only one operative mortality. Following SVR, mean ejection fraction improved from 26% to 35% (p = 0.02), with a reduction in mean left ventricular end-systolic volume index from 93 mL/m² to 68 mL/m² (p = 0.04). Seventy-three percent (16/22) of patients in preoperative NYHA class III/IV improved to class I/II at follow-up (p < 0.0001). Actuarial survival was 74% at 30 months. Recent MI was not an independent predictor of adverse outcomes following SVR in our series.

Conclusion

Recent MI patients demonstrate significant improvement in ventricular function and NYHA class with acceptable morbidity and mortality following SVR. These findings prompt consideration of expanding the inclusion criteria for SVR to include patients who have sustained a recent MI.