Does Preoperative ejection fraction predict operative mortality with left ventricular restoration?

Background. Ischemic cardiomyopathy and aneurysmal disease have been treated surgically with coronary artery bypass grafting in the past. The Dor technique for left ventricular restoration has demonstrated improved outcomes in patients with ischemic, akinetic ventricles. Our hypothesis was that even marked reduction in preoperative cardiac function ( ejection fraction < .25) would not correlate with worse outcomes since the ventricle would be reshaped to improve function. Methods. A retrospective analysis was performed on all patients who had undergone ventricular restoration with the Dor procedure from January 1996 through September 2005. Patients with a preoperative ejection fraction ( EF) < .25 and those with a EF > .25 were compared. All Society of Thoracic Surgeons database characteristics, mortality, length of stay ( LOS), and need for intraaortic balloon pump ( IABP) were analyzed. Results. The study included 89 patients ( 69 men, 20 women), 28 of whom had preoperative EFs < .25 ( mean, .183 +/- .035; range, .08 to .25) and 61 had an EF > .25 ( mean, .334 +/- .074; mean, .25 to .45). Overall operative mortality was 3.4% ( 3/89), with no statistically significant difference between the two groups ( 3.6% versus 3.3%). LOS was 7.4 +/- 3.6 days versus 8.9 +/- 15.6 days ( p = NS), and need for IABP was 39.2% versus 8.1% ( p < 0.05). Overall 5-year survival was 82%. Five-year survival in the EF < .25 cohort was 69.6% versus 88.3% in the EF > .25 cohort ( p = 0.066). Conclusions. Ventricular restoration with the Dor technique is a safe procedure. Marked reduction in ejection fraction is not a contraindication to left ventricular restoration; however, increased usage of IABP should be anticipated.