NDLI: Predictors of adverse events after surgical ventricular restoration for advanced ischaemic cardiomyopathy.

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

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

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Pocar, Marco Di Mauro, Alessandra Passolunghi, Davide Moneta, Andrea Alsheraei, Al Megalli Tantawi Ali Bregasi, Alda Mattioli, Roberto Donatelli, Francesco
Description	Country affiliation: Italy Author Affiliation: Pocar M ( Dipartimento di Scienze Cardiovascolari, Università degli Studi di Milano, IRCCS MultiMedica, Via Milanese 300, I-20099 Sesto San Giovanni, Milano, Italy. marco.pocar@unimi.it)
Abstract	OBJECTIVE: Post-infarction ventricular remodelling has been graded (I-III) according to the loss of systolic left ventricular silhouette curvature changes. Although surgical ventricular restoration (SVR) has been extended to type III ischaemic cardiomyopathy, the results are less satisfactory. We sought to identify geometric and functional predictors of late outcome after SVR. METHODS: Among 144 patients who underwent SVR since 1998, a subgroup of 31 patients (age: 65.2+/-7.6 years) was analysed. Inclusion criteria were: type III cardiomyopathy, no associated procedure except coronary artery bypass grafting, prior anterior infarction, absent-to-2+ mitral regurgitation, elective operation, follow-up > or =18 months (mean: 44+/-26; longest: 96 months). Probability of events was estimated with the Kaplan-Meier method. A Cox multivariable regression model was constructed selecting eight potential predictors of four adverse events: death, cardiac death, recurrent heart failure (New York Heart Association class III or IV) and left ventricular re-remodelling, defined as a 25% increase of end-systolic volume index after SVR, or an end-systolic volume index > or =50 ml.m(-2). RESULTS: Early and late mortality were zero and 6% (2/31 patients, one cardiac-related death). NYHA class and all echocardiographic functional variables significantly improved early after SVR. Freedom (+/-standard error (SE)) from heart failure was 97%+/-3%, 93%+/-5%, 77%+/-11% and 64%+/-15%, whereas freedom from left ventricular re-remodelling was 97%+/-3%, 80%+/-8%, 60%+/-12% and 39%+/-15%, respectively, 1, 3, 5 and 7 years after SVR. Multivariable analysis identified baseline mitral regurgitation degree and sphericity index as independent predictors of recurrent heart failure (p=0.025; hazard ratio (HR)=7.80 (95% confidence intervals (CIs): 1.29-47.19)) and left ventricular re-remodelling (p=0.047; HR=2.84 (95% CIs: 1.01-7.95)). Both predictors also correlated with a higher recurrence of end-systolic volume index > or =50 ml.m(-2) at late follow-up. CONCLUSIONS: 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.
File Format	HTM / HTML
ISSN	10107940
e-ISSN	1873734X
Journal	European Journal of Cardio-Thoracic Surgery
Issue Number	5
Volume Number	37
Language	English
Publisher	Oxford University Press
Publisher Date	2010-05-01
Publisher Place	Germany
Access Restriction	Open
Subject Keyword	Discipline Cardiology__semicolon__surgery Cardiomyopathy, Dilated Surgery Heart Ventricles Etiology Physiopathology Epidemiologic Methods Heart Failure Prevention & Control Mitral Valve Insufficiency Complications Myocardial Infarction Postoperative Complications Prognosis Ultrasonography Ventricular Remodeling Physiology Evaluation Studies
Content Type	Text
Resource Type	Article
Subject	Pulmonary and Respiratory Medicine Surgery Cardiology and Cardiovascular Medicine

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