Enfermedades cardiovasculares y diagnóstico

Impact of Surgical Ventricular Restoration on Cardiac Function, Ischaemic Mitral Regurgitation and Long-term Survival

Abstract

Rizwan Attia, Hannah Flemming, Katharina Schulte, John Chambers, Christopher Young, Graham Venn and Fikrat Shabbo

Objectives: Adverse cardiac remodelling is a major cause of morbidity and mortality post myocardial infarction. The role of surgical ventricular restoration compared to medical and electrophysiological treatments has recently come under intense scrutiny. We aimed to evaluate 10-year clinical outcomes of surgical ventricular restoration in our institution. Methods: From January 2001 to 2011, surgical ventricular restoration was performed in 126 consecutive patients (M2.3: 1F), mean age 65.5 (44-86) years. All patients presented with angina, heart failure and/or ventricular tachycardia. Post-infarction left ventricular aneurysm was present in all patients and ischemic dilated cardiomyopathy with a large akinetic left ventricle in 11.6%. The preoperative left ventricular ejection fraction was 33.1 ± 8.9%. Multi-vessel disease was present in 117/126(93%) patients. Mitral regurgitation more than grade+2 was found in 39/126(31%). The mean Logistic EuroSCORE was 13.8 ± 5.9%. A minimum of two-year post-operative follow-up was obtained on all patients. Results: Most patients underwent endoventricular or elliptical patch repair; 94% had concomitant coronary revascularisation with a median of 2 grafts and 5% had mitral valve repair. Intra-aortic balloon pump was placed preoperatively in 24/126 (19%) patients while 21/126 (17%) needed inotropic support for more than 24 h. Postoperative stroke occurred in 2 patients. In-hospital mortality was 7/126 (5.5%). All cause cardiovascular mortality at ten years was 12/126 (9.5%). Mean follow-up in operative survivors was 8.2 ± 1.2 years. Actuarial survival was 95.3%, 90.6%, 86.3% and 79.1% at 1-month, 1, 5 and 10-years. Echocardiographic follow-up demonstrated a reduction in the mean left ventricular end-diastolic volume and left atrial diameter. Ejection fraction improved over first year from 33.1 ± 8.9 to 45 ± 8.6% (P<0.006). Conclusions: Left ventricular reconstruction surgery is a good surgical option for treatment of post-infarction left ventricular aneurysm.