Early and late outcome of left ventricular reconstruction surgery in ischemic heart disease

Abstract

A systematic review of the literature was performed to determine early and late mortality associated with left ventricular (LV) reconstruction surgery and to assess the influence of different surgical techniques, concomitant surgical procedures, clinical and hemodynamic parameters on mortality. The MEDLINE database (January 1980-January 2005) was searched and from the pooled data, hospital mortality and survival were calculated. Summary estimates of relative risks (RR) were calculated for the techniques that were used and for concomitant coronary artery bypass grafting (CABG) and mitral valve surgery. The risk-adjusted relationships between mortality and clinical and hemodynamic parameters were assessed by meta-regression. A total of 62 studies (12,331 patients) were identified. Weighted average early mortality was 6.9%. Cumulative 1-year, 5-year and 10-year survival were 88.5%, 71.5% and 53.9%, respectively. Endoventricular reconstruction (EVR) showed a reduced risk for both early (RR=0.79, p<0.005) and late (RR=0.67, p<0.001) mortality compared to the linear repair (early: RR=1.38, p<0.001; late: RR=1.83, p<0.001). Early and late mortality were mainly cardiac in origin, with as predominant cause heart failure in respectively 49.7% and 34.5% of the cases. Ventricular arrhythmias caused 16.6% of early deaths and 17.2% of late deaths. Concomitant CABG significantly decreased late mortality (RR=0.28, p<0.001) without increasing early mortality (RR=1.018, p=0.858). Concomitant mitral valve surgery showed both an increased risk for early (RR=1.57, p=0.001) and late mortality (RR=4.28, p<0.001). No clinical or hemodynamic parameters were found to influence mortality. It is noteworthy that only one third of patients included in the current analysis were operated for heart failure (14 studies, 4135 patients). In this group we noted an early mortality of 11.0% with a late mortality (3-year) of 15.2%. This analysis of pooled literature data showed that LV reconstruction surgery is performed with acceptable mortality and EVR may be the preferred technique with a reduced risk for early and late mortality. Concomitant CABG improved outcome, whereas the need for mitral valve surgery appeared an index of gravity. No clinical or hemodynamic parameters were found to influence mortality; specifically LV ejection fraction and LV volumes both did not predict outcome.

Surgical left ventricular reconstruction

“…24 A number of parameters have been traditionally identifi ed that infl uence early and late mortality. 25 A low LV ejection fraction (LVEF) has been reported in earlier reports to be a predictor of higher early and late mortality. [26][27][28][29] The observation that LV dilatation is more closely related to outcome than a decreased LVEF was fi rst described by White et al, who showed a correlation between increased LV volumes after MI with increased mortality.…”

Surgical Ventricular Restoration for Ischemic Cardiomyopathy with Functional Mitral Regurgitation

“…A l t h o u g h t h e r e i s n o g o l d s t a n d a r d technique for patients with ICM and functional MR, our combined surgery appears to achieve the final goal at this moment. For patients with ischemic heart disease, SVR has yielded beneficial short-term effects on functional status, exercise performance, long-term results, and quality of life 48,49) . However, concomitant SVR is still controversial during CABG for these patients 48,49,50) .…”

“…For patients with ischemic heart disease, SVR has yielded beneficial short-term effects on functional status, exercise performance, long-term results, and quality of life 48,49) . However, concomitant SVR is still controversial during CABG for these patients 48,49,50) . Recently, the Surgical Treatment for Ischemic Heart Failure (STICH) trial addressed this question and demonstrated that anatomical change by SVR was not associated with a greater improvement in symptoms or exercise tolerance or with a reduction in the rate of death or hospitalization for cardiac causes 50) .…”

“…Due to the diverse patient population, it is very difficult to compare the surgical outcomes among clinical studies and trials. Although details of patients' background were disregarded, the cumulative survival rate was assessed by a systematic review of the literature associated with SVR in ischemic heart disease 48) . According to the review, the weighted average early mortality (defined as in-hospital or 30-day mortality) was 6.9%, and the cumulative 1-year and 5-year survivals were 88.5% and 71.5%, respectively.…”

Off-pump anteroapical aneurysm plication following left ventricular postinfarction aneurysm: effect on cardiac function, clinical status and survival

“…[1][2][3] The most commonly used techniques are endoventricular repair, with or without the use of an endoventricular patch, introduced by Dor in 1989, 4 and linear repair. Previous studies have demonstrated that a dyskinetic aneurysm, in contrast to an akinetic aneurysm, is associated with better postoperative improvement in LV function and lower operative mortality.…”