Long-Term Survival and Echocardiographic Findings After Surgical Ventricular Restoration

Abstract

Background. This study investigates the long-term survival and durability of mitral procedures on patients undergoing surgical ventricular restoration.Methods. From 1992 to 2017, 109 patients underwent surgical ventricular restoration. Survival was determined from hospital records and the National Death Index. Preoperative demographics, clinical characteristics and features, operative technique, and follow-up echocardiography findings were analyzed using Cox regression and log-rank to determine variables influencing survival.Results. The mean age was 61.57 ± 12.81 years. There were 101 (93%) true and 8 (7%) pseudo-aneurysms. Concomitant surgeries included mitral valve (MV) repair (n [ 40, 37%), MV replacement (n [ 5, 5%), tricuspid valve repair (n [ 4, 4%), aortic valve replacement (n [ 3, 3%), coronary bypass grafting (n [ 76, 70%; 1.6 ± 1.3 grafts), and ventricular septal defect closure (n [ 5, 5%). Redosternotomies were performed in 12 patients (11%). Median duration of echocardiographic follow up was 2.9 years (interquartile range, 9.0) and was obtained in 59 patients

Clinical and hemodynamic outcomes of the Dor procedure in adults with ischemic cardiomyopathy

“…Nonetheless, there are some differences depending on technique and patient characteristics. Operative mortality is reported between 0% and 5% with risk factors being those described earlier, such as HF severity, NYHA class and advanced age 8,28,62,96 . After SVR, the hospital and 30‐day mortality varies from 2% to 7.8% depending on the study sample 11,48,51,52,68,97–99 .…”

“…The first parameter that is considered preoperatively is right ventricular (RV) dysfunction as measured by multiple variables, including wall motion and chamber size. Preoperative RV dysfunction and high filling pressures have been associated with worse baseline values, as well as decreased diastolic function post‐SVR 28,29 . Traditionally, studies have focused on volume, specifically low end‐diastolic volume (EDV) as a correlate for worse diastolic function postoperatively.…”

“…In patients with a previous myocardial infarct, SVR has resulted in significant EF improvements postoperatively, both immediately and/or in longer‐term follow‐up of a year or greater 21,28,36,37,42,46,51,52,55–65 . Although many studies report an increase in EF with continued improvement during follow‐up years, others do report some decline or evidence of remodeling after 18–22 months 61,62 …”

“…The theory proposed is that all three issues are being treated: the valve with mitral annuloplasty, the dilated ventricle with SVR and the ischemic vessel with CABG. Unfortunately, the data on tricuspid valve regurgitation is not as clear with sources claiming both increased and decreased tricuspid regurgitation postoperatively 28,37 . More detailed studies are warranted to better understand how clinical outcomes are affected by tricuspid valve disease in the context of SVR with or without coronary surgery.…”

“…The most common risk factors for mortality include high LVESVI, high NYHA functional class, advanced age (>75 years), severity of MR, low EF, and restrictive filling pattern 23,28,34,47,63–65 . Although these factors are common to many studies, they cannot be generalized to all patients and cut‐off margins vary.…”