Surgical Ventricular Restoration: Long-Term Results in Ventricular Remodeling and Risk of Arrhythmias

Background: Surgical ventricular reconstruction (SVR) isperformed in patients with post-infarction left ventricularremodeling with the aim of reducing ventricular volumesthrough the exclusion of most of the scarred tissue and toreduce the incidence of inducible ventricular tachycardia. It is not known whether SVR without concomitant anti-arrhythmic surgical procedures is sufficient for the prevention of late arrhythmias or sudden death. Methods: Patientswho underwent SVR at our center from January 2008 toFebruary 2021 were included in the study. All patients adcomplete clinical and echocardiographic evaluations before surgery, after surgery and at follow up. Results: Overall, 55 patients were included (mean age 61.5±10 years), 45 male (82%). One patient died intraoperatively due to a massive thrombus embolization from the aneurysmal cardiacapex to the coronary ostia. Complete bypass grafting wasfirst performed when indicated in 28 patients (51%); concomitant mitral valve treatment was performed in 5 patients (9%). A total of 19 patients under went rescue percutaneous coronary intervention (35%). An implantable cardioverter-defibrillator (ICD) was implanted in 13 patients (24%) in the postoperative period (almost 3 months post-op). All surviving patients underwent follow-up (mean 8.5±4.5 years) with complete clinical and echocardiographic examination. The Cox regression model revealed that, after accountingfor confounding factors such as sex, age, smoking, hyper-tension, previous stroke, diabetes, ICD implantation doesnot significantly improve patient survival. However, a univariate analysis comparing total mortality and sudden death in patients with vs without ICD showed a significant difference. Conclusions: SVR is effective in improving patientsymptoms and ventricular function. However, as this technique does not involve ablative treatments, the risk of sudden death remains high and patients should undergo electrophysiological re-evaluation for preventive ICD implantation.