Predictors of adverse events after surgical ventricular restoration for advanced ischaemic cardiomyopathy☆

Abstract

Despite advanced cardiomyopathy, SVR determines left ventricular volume reduction and improved systolic function. Baseline absent-to-moderate mitral regurgitation and a more spherical left ventricular geometry predict a less favourable clinical and functional outcome, suggesting a possible rationale for wider indications for combined correction of 2+ mitral regurgitation and undersizing of the mitral annulus, particularly in patients with sphericity index > or =0.75.

Editorial commentSurgical planning for surgical ventricular restoration involves decision options on form versus disease

“…The postoperative 12-and 18-month ESVI data of Pocar et al [1] (displayed in their Table II and Fig. 1) emphasise the dramatic difference in the recorded progression of this essential volume measurement compared to the unchanged, but traditionally evaluated ejection fraction.…”

“…Pocar et al [1] define 'predictors of adverse events after surgical ventricular restoration (SVR) for advanced ischaemic cardiomyopathy' and provide a very insightful analysis that addresses (a) how ventricular geometry (sphericity) and mitral regurgitation (MR) impact prognosis and (b) why the decision-making process during surgical management in dilated congestive heart failure (CHF) patients is principally determined by how these two prognosis-related factors are managed.…”

Lessons from a mathematical hypothesis — modification of the endoventricular circular patch plasty

“…Linear plication failed to exclude the infracted septum, did not improve systolic and diastolic functions, and demonstrated ventricular re-dilatation [6]. The EVCPP performed with concomitant coronary bypass and mitral valve repair resulted in better ventricular geometry and systolic function [8,9].…”

“…One of the several reasons for the failure of the success of SVR in this trial is the technique of SVR employed. Pocar et al [6] have defined the reasons for failure of the EVCPP technique of SVR in an elegant meta-analysis, and have aptly concluded that restoration of an ellipsoid left-ventricular geometry has optimal clinical benefits, both at short-and long term. The reasons for failure of the existing technique have been elucidated along with its effects on long term remodeling.…”

“…The shape changes following EVCPP document changes confined to the inferior wall [11]. In addition, there was late re-remodeling of the postoperative ventricle, defined as 25% increase in the end systolic volume index (ESVI) late after surgery or an ESVI of > 50 ml m À2 body surface area (BSA) [6]. The recently concluded STICH trial stated that surgical ventricular restoration had no benefit over surgical coronary revascularization alone [12].…”