Surgical ventricular restoration based on evaluation of myocardial viability with delayed-enhanced magnetic resonance imaging

OBJECTIVE: We examined whether the determination of myocardial viability by preoperative delayed-enhanced magnetic resonance imaging (DE-MRI) would be useful for planning surgical ventricular restoration (SVR). METHODS: Eight consecutive patients with poor cardiac function (ejection fraction < 30%) due to ischemic cardiomyopathy underwent surgical treatment based on findings of preoperative cine-MRI and DE-MRI. Our surgical strategy consisted of (1) complete revascularization on viable segments; (2) SVR in a patient with extensive nonviable segments; and (3) mitral valve plasty in a patient with a more than moderate degree of mitral regurgitation. Based on the MRI assessments, four of the patients (group A) underwent isolated coronary bypass surgery, and the other four (group B) underwent SVR and mitral valve plasty concomitantly with coronary bypass surgery. Perioperative changes in ventricular function were quantitatively assessed in each group. RESULTS: The mean end-diastolic volume index was reduced from 115 +/- 29 ml/m2 to 95 +/- 14ml/m2 in group A and from 163 +/- 35ml/m2 to 125 +/- 28ml/m2 in group B. The mean end-systolic volume index was reduced from 91 +/- 25ml/m2 to 68 +/- 16ml/m2 in group A and from 135 +/- 36ml/m2 to 98 +/- 28 ml/m2 in group B. The mean ejection fraction increased from 20% +/- 6% to 28% +/- 9% in group A and from 17% +/- 6% to 22% +/- 5% in group B. The mean New York Heart Association (NYHA) functional class was reduced from 3.0 +/- 0.8 to 1.8 +/- 0.6 in group A and from 3.5 +/- 0.5 to 2.2 +/- 0.2 in group B. CONCLUSION: DE-MRI was highly effective in helping to select which patients and which areas of the left ventricle are indicated for SVR, which contributed to excellent early clinical outcomes.