Ischemic dilatative cardiomyopathy and aneurysms of the left ventricular cavity: transplantation vs alternative surgery.

Patients with terminal end-stage heart failure due to severe coronary disease associated with dilatative cardiomyopathy have an annual mortality of 30-50%. Between July 1997 and December 1999, 21 patients at the University Hospital in Frankfurt, and 25 patients from Skopje underwent total circular repair with simultaneous coronary artery bypass.

Transplantation or alternative surgical treatment of patients with ischemic dilative cardiomyopathy and aneurysmatic dilation of the left ventricular cavity.

BACKGROUND: Patients with terminal ischemic heart disease (IHD), severely depressed pump function with large LV dyskinesis with or without fibrosis do not benefit from revascularization alone; in time they are listed for transplantation. The long waiting list and lack of organ donors have imposed implementation of Direct Circular Repair (DCR) with total revascularization as an alternative. METHODS: DCR was performed on 17 patients with terminal IHD, after total revascularisation. The resected dyskinetic tissue was pathohistologicaly examined. Transesophageal ultrasound was performed pre- and early post-operatively and hemodynamic parameters measured invasively. RESULTS: Pathohistology showed that even in macroscopically viable myocardium where only dyskinesia without fibrosis persists, there are irreversible lesions on the ultrastructural level. Along with revascularization, with the application of DCR the LV spherical geometry was reconstructed with hemodynamic improvement. CONCLUSION: Total revascularisation with DCR offers an alternative to transplantation in patients with wide anterior wall dyskinesia with or without fibrosis due to terminal IHD, the most frequent group listed for transplantation.