Surgery of Left Ventricular Aneurysm: A Meta-Analysis of Early Outcomes Following Different Reconstruction Techniques

Parolari, Alessandro; Naliato, Moreno; Loardi, Claudia; Denti, Paolo; Trezzi, Matteo; Zanobini, Marco; Porqueddu, Massimo; Roberto, Maurizio; Kassem, Samer; Alamanni, Francesco; Tremoli, Elena; Biglioli, Paolo

doi:10.1016/j.athoracsur.2007.01.032

Cited by 25 publications

(16 citation statements)

References 31 publications

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“…The reconstruction of the LV wall using a circular patch did however show a significantly reduced risk for early mortality (RR = 0.60, p = 0.001), but again patient numbers for this technique are limited. In the meta-analysis by Parolari et al concerning the early outcomes following different LV reconstruction techniques, the authors also concluded that geometric reconstruction carries a reduced risk for early mortality compared to linear repair [90]. In contrast, in a sub-analysis comparing geometric and linear reconstruction techniques that were carried out in the same time lag, a difference in early mortality could not be demonstrated.…”

Section: Surgical Techniques and Mortalitymentioning

confidence: 85%

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

Klein

Bax

Shaw³

et al. 2008

European Journal of Cardio-Thoracic Surgery

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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.

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Section: Surgical Techniques and Mortalitymentioning

confidence: 85%

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

Klein

Bax

Shaw³

et al. 2008

European Journal of Cardio-Thoracic Surgery

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“…However, patients for SVR need to be carefully selected, and overaggressive LV reduction can result in restrictive physiology. The alternate technique of endoaneurysmorrhaphy (using a linear closure technique) showed a slightly better outcome in a recent meta-analysis [27]. The ongoing STICH trial will provide data on the long-term outcome of SVR [18].…”

Section: Reconstructionmentioning

confidence: 95%

Current and novel cardiac support therapies

Jugdutt

2009

Curr Heart Fail Rep

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Despite optimal medical therapy, many heart failure patients progress to end-stage disease associated with reduced quality of life and poor outcome. However, these patients can benefit from current novel cardiac support strategies, including ventricular assist devices (VADs), cardiac support devices (CSDs), and future cell- and/or matrix-based therapies. The most exciting goal in using VADs and CSDs is to achieve reverse remodeling, suppression of remodeling gene programs, and activation of myocardial recovery programs, which will improve left ventricular shape, size, and function. Long-term left VADs are effective, but recovery upon removal is uncommon. Passive CSDs (eg, Acorn devices) are very promising as long-term devices for therapy of end-stage heart failure and reversal of structural and biochemical remodeling. Expanding CSD use to include preventing progressive adverse left ventricular remodeling after ST-segment elevation myocardial infarction requires further study. The combination of cell- and/or matrix-based therapies with CSDs is under investigation.

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“…With the advent of cardiopulmonary bypass, the treatment was performed with resection of necrotic and/ or ischemic tissue [4], represented by akinetic or dyskinetic areas, by ventricular resection surgery, with plication or linear closure, which became the "gold standard" in the following decades. However, with this technique on which the area at risk of being resected is very important in left ventricular function, and on which its resection causes not only decrease of the volume and shape of the remaining ventricular cavity, as well as loss of contractile force and ventricular geometry, there is improvement of the original presentation, but with unsatisfactory mid-and long-term evolution [5].…”

Section: Almeida Rms -Surgical Left Ventricular Reverse Remodeling: mentioning

confidence: 99%

Remodelamento reverso cirúrgico do ventrículo esquerdo: seguimento de 111 meses

Almeida¹

2009

Rev Bras Cir Cardiovasc

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Surgery of Left Ventricular Aneurysm: A Meta-Analysis of Early Outcomes Following Different Reconstruction Techniques

Cited by 25 publications

References 31 publications

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

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

Current and novel cardiac support therapies

Remodelamento reverso cirúrgico do ventrículo esquerdo: seguimento de 111 meses

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