Apical compression stitch in patients with failing left ventricles: A new option for surgical remodelling technique

Objectives: The apical compression stitch is a surgical option for patients with dilated cardiomyopathy to preserve the geometry of the left ventricle. We present our mid-term results of a prospective randomized trial.

Methods: In 26 randomized patients (mean age 65 ± 8) with impaired left ventricular ejection fraction (EF) mean 25 ± 8% undergoing coronary artery bypass grafting (CABG) left ventricular (LV) geometry was evaluated by MRI (Magnetic Resonance Imaging) scanning before, after surgery and at follow up (FU). 81% of the patients were in New York Heart Association (NYHA) functional class 3 and 19% in NYHA 4 preoperatively. Seattle heart failure model estimated a mean life expectancy of 8.71 ± 2 years. In 12 patients the apical compression stitch was additionally performed with special U-stitches. We compared the apical compression group (ACG) with the non ACG.

Results: We could observe an improvement of the LVEF in the follow up (50 ± 6% in the ACG versus 40 ± 7% in the non ACG). The LVEF difference between preoperative to follow up was significantly higher in the ACG (p = 0.015). 71% of the patients were in NYHA class 1, 25% in NYHA class 2 and 4% in NYHA class 3. Two patients died in the FU; one because of bowel cancer, the other one because of ischemia of the bowel. Mean follow up time was 4.5 ± 2 years.

Conclusion: Spherical distension of the left ventricular dimensions causes cardiac decompensation. After compression of the apex ventricular function and clinical status improve. Patients with impaired LV function and apical dilatation benefit from this new surgical remodelling technique.