Surgical anterior ventricular endocardial restoration performed with total arterial revascularization: Serial 5-year follow-up

ObjectiveWe evaluated the changes in left ventricular (LV) function and volumes after surgical anterior ventricular endocardial restoration.MethodsA total of 63 patients who had undergone surgical anterior ventricular endocardial restoration and total arterial revascularization were included. Echocardiography and myocardial single photon emission computed tomography were performed to examine LV function and volumes preoperatively, early postoperatively, and annually thereafter to 5 years after surgery. Coronary angiography was performed at 5 years postoperatively.ResultsOperative mortality was 7.9% (5 of 63). Echocardiograms performed before discharge demonstrated a significantly improved LV ejection fraction that was maintained at 5 years, significantly decreased early postoperative LV end-diastolic and end-systolic volume indexes that were slightly increased at 1 year and then maintained at 5 years, and early postoperative decrement of the stroke volume index that had disappeared at 1 year and had not reappeared by 5 years. Postoperative myocardial single photon emission computed tomography showed an LV ejection fraction that had gradually improved until 2 years and was maintained at 5 years, significantly decreased LV end-diastolic and end-systolic volume indexes that were maintained at 5 years, and a stroke volume index that was unchanged until 2 years and slightly increased at 3 to 4 years. The arterial graft patency rate in the left coronary territory was 95.7% (67 of 70) at 5 years. The 10-year overall survival and adverse event-free rate were 59.2% and 61.2%, respectively.ConclusionsImproved LV ejection fraction and reduced volume indexes were maintained and the stroke volume index had not decreased at 5 years after the procedure. Preserved patency of the arterial grafts might have an important role in maintaining improved LV function.