Surgical treatment for heart failure in ischemic cardiomyopathy

Background. Cardiac transplantation remains the gold standard of surgical therapies for severe LV dysfunction ischemic cardiomyopathy. However, the Achilles heel of heart transplantation is the shortage of organ donors. Thus, nontransplant surgical alternatives are necessary to treat many of the patients who progress to intractable Class III, or especially Class IV, heart failure. Methods: Two hundred and twelve consecutive patients (57 women and 155 men; average age 64 12 years old) who underwent surgical revascularization with or without combined mitral repair (or replacement) and left ventricular reconstruction between 1999 and 2005 were retrospectively analyzed. Results: The in-hospital or 30-day mortality rate was 6.60%. At a median follow-up of 32 months (range, 6-88 months), 48.7 % of the patients were alive at 5 years. Conclusion: The results of our study confirm that surgical revascularization with or without combined mitral repair (or replacement) and left ventricular reconstruction for patients with severe LV dysfunction are presently the common and promising surgical approaches, with surprisingly low operative mortality and encouraging intermediate results.