Functional results of left ventricular reconstruction

Salati, Maurizio; Biasi, Pietro Di; Pajè, Antonella; Cialfi, Alessandro; Bozzi, Giorgio; Santoli, C

doi:10.1016/0003-4975(93)91167-l

Cited by 10 publications

(3 citation statements)

References 27 publications

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“…The other 40% had a residual deformity of the ventricular chamber with an asymmetric contraction pattern. 3 We have emphasized the predictive role of a successful geometric reconstruction of the well-preserved proximal interventricular septum. 1°…”

Section: Discussionmentioning

confidence: 99%

Severe diastolic dysfunction after endoventriculoplasty

Salati¹,

Pajè²,

Biasi³

et al. 1995

The Journal of Thoracic and Cardiovascular Surgery

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Endoventriculoplasty with pericardial patch has been advocated to repair anteroseptal ventricular aneurysm, but not studies have reported the influence of this technique on diastolic left ventricular function. We have evaluated the changes on ventricular filling by means of pulsed Doppler recording of diastolic transmitral flow. Doppler analysis reveals three distinct spectral patterns: (1) normal, (2) inverted, and (3) restrictive. We have found an abrupt change from a preoperative normal to postoperative restrictive pattern in a significant minority of patients (8%) who underwent endoventriculoplasty. These patients had clinical and hemodynamic signs (New York Heart Association class, time from anterior myocardial infarction, left ventricular end-diastolic pressure, pulmonary hypertension, and mitral regurgitation) of severe impairment but no differences were found in ejection fraction, aneurysmal extension, or remote myocardial function. Moreover, after operation they had a satisfactory ejection fraction, a low end-diastolic volume, and an apex-base length shorter than the predicted value for a normal population. The presence of a postoperative restrictive pattern of diastolic filling is a strong predictor of 3-month mortality and makes the medical treatment difficult. Caution must be taken to perform endoventriculoplasty in patients who are severely ill, especially those recently affected by myocardial infarction. When the clinical conditions dictate the operation, a nonenthusiastic volume reduction seems to be a prudent option.

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Section: Discussionmentioning

confidence: 99%

Severe diastolic dysfunction after endoventriculoplasty

Salati¹,

Pajè²,

Biasi³

et al. 1995

The Journal of Thoracic and Cardiovascular Surgery

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“…Forty-seven studies also reported on long-term survival [71][72][73][74], following 8571 patients for a median of 49 months. Cumulative 1-, 5-and 10-year survival was 88.5%, 71.5% and 53.9%, respectively (Fig.…”

Section: Early and Late Mortality In LV Reconstruction Surgerymentioning

confidence: 95%

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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“…Recent studies have reported operative mortality rates ranging from 4 to 17.5% [18,19], There were few perioperative complications. Only 15% of patients re quired intra-aortic balloon support intraoperatively or postopcrativcly.…”

Section: Resultsmentioning

confidence: 99%

Left Ventricular Endoaneurysmorrhaphy: Effect on Left Ventricular Size, Shape and Function

Çïçek

Demirkılıç²,

Tatar³

et al. 1997

Cardiology

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Left ventricular (LV) endoaneurysmorrhaphy is a relatively new surgical procedure with excellent results. Forty-five patients underwent surgical repair of LV aneurysm with LV endoaneurysmorrhaphy from 1991 to 1995. The main indication for operation was angina pectoris (71 %). Concomitant myocardial revascularization was performed in 97% of the patients. The operative mortality rate was 2.2%. Pharmacologic inotropic support was required in 31% and mechanical support in 15%. Mean echocardiographic ejection fraction improved from 29.6% preoperatively to 48.3% postoperatively (p < O.OOl). LV end-diastolic volumes were 195 ± 63 and 118 ± 44 ml before and after surgery (p < O.Ol). Intraoperative transesophageal echocardiography revealed normal or near-normal LV shape in all cases. The mean follow-up was 34.0 ± 9.2 months (16-50 months) and 1 patient died 9 months postoperatively. We conclude that endoaneurysmorrhaphy improves LV geometry and function in patients with LV aneurysms and can be performed with low surgical risk even in patients with large aneurysms and severely depressed LV function.

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Functional results of left ventricular reconstruction

Cited by 10 publications

References 27 publications

Severe diastolic dysfunction after endoventriculoplasty

Severe diastolic dysfunction after endoventriculoplasty

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

Left Ventricular Endoaneurysmorrhaphy: Effect on Left Ventricular Size, Shape and Function

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