eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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2/2008
vol. 5
 
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abstract:

Kardiochirurgia dorosłych
The results of surgical left ventricular restoration

Marek A. Deja
,
Piotr Janusiewicz
,
Jolanta Biernat
,
Marcin Malinowski
,
Krzysztof S. Gołba
,
Wojciech Domaradzki
,
Ryszard Bachowski
,
Marek Jasiński
,
Wojciech Ceglarek
,
Stanisław Woś

Kardiochirurgia i Torakochirurgia Polska 2008; 5 (2): 112–115
Online publish date: 2008/06/20
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Aim: To assess early and late results of surgical ventricular reconstruction (SVR).
Material and Methods: Over 8 years we operated on 102 patients (75 males) of mean age 63±7. Initial LVEDV was 219±65 ml, ESV 150±55 ml, and EF 32±8%. In 53 patients (52%) we used patches to perform SVR. On average 2.9±1.1 coronary artery bypass grafts were implanted per patient (min. 0 – max. 5). In 43 (42%) patients we performed MV repair, in 1 MVR, in 4 TV repair, in 1 post-infarction VSD repair, in 1 ASD repair, in 1 AVR and in 1 ascending aorta replacement.
Results: There were 8 perioperative deaths (7.8%). One-, 2-, 3-, and 5-year survival was: 83±5%, 76±5%, 72±6% and 62±7% respectively. As a result of SVR EDV dropped to 172±52 ml (p<0.001), ESV to 112±50 ml (p<0.001) and EF increased to 37±11% (p=0.053) in the last echocardiographic follow-up. On the last visit NYHA class was 1.6±0.7 – significantly less than preop 2.1±0.9 (p=0.009), and CCS class 0.6±0.6, less than preoperative 1.6±1.2 (p<0.001). Mitral valve repair increased perioperative mortality, 13.9% vs. 3.4% (p=0.1), and late mortality: 3-year survival 63±8 vs. 80±8% (p=0.04). The influence of higher preoperative LV volume was not significant on survival. In multivariate analysis LV EF <30% increased late mortality – OR 3.0 (95% CI 1.1-7.7) p=0.02.
Conclusions: SVR may be added to CABG in ischaemic cardiomyopathy with reasonable operative risk. Long-term survival of our patients appears less than in the RESTORE group. The influence of SVR on long-term survival requires assessment in randomized trials.
keywords:

ischaemic cardiomyopathy, surgical ventricular restoration, mitral valve repair
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