The Role of Left Ventricular Reconstruction in Ischemic Cardiomyopathy

Furukawa Koji, Sakaguchi Shuhei, Mori Kousuke

doi:10.7793/jcad.31.006

We review the relevant literature and our own experience to identify cases in which left ventricular reconstruction (LVR) has been successful, particularly for ischemic cardiomyopathy (ICM). Despite substantial advances in medical and device therapies, surgical treatment of ICM remains important. In this context, LVR for ICM is expected to play a complementary role between heart transplantation or ventricular assist device therapy and surgical treatments such as coronary artery bypass surgery. However, the number of LVRs performed has decreased. This may be because of the lack of well-established cases of successful LVR. Although a good outcome can be expected if the left ventricular (LV) volume is controlled after LVR, it is difficult to identify surgical responders based on preoperative LV volume. Here, we focused on the LV diastolic function, assessed by the echocardiographic mitral inflow waveform ratio (E/A ratio), as an index of the degree of progression of LV remodeling and examined the outcomes of LVR. The preserved LV diastolic function group (E/A ratio < 2) had significantly better outcomes than the impaired LV diastolic function group. The relationship between the degree of LV diastolic function and the efficacy of LVR has recently been investigated. Additionally, LVR has evolved from the resection of ventricular aneurysms to the isolation of the infarct area, reduction of LV volume, and restoration of the normal conical structure of the left ventricle, with promising results. Therefore, selective LVR is an option for HF treatment of heart failure.

The Role of Left Ventricular Reconstruction in Ischemic Cardiomyopathy

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