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J Thorac Cardiovasc Surg 2004;127:1648-1656
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Determinants of postinfarction remodeling affect outcome and left ventricular geometry after surgical treatment of ischemic cardiomyopathy

^a Department of Cardiac Surgery, Echocardiography Laboratory, Poliambulanza Hospital, Brescia, Italy
^b Department of Cardiology, Echocardiography Laboratory, Poliambulanza Hospital, Brescia, Italy
^c Department of "Mathematics and Statistic Applied to Economics," University of Pisa, Pisa, Italy

Received for publication June 24, 2003; revisions received November 10, 2003; accepted for publication November 24, 2003.

^* Address for reprints: Marco Cirillo, MD, Poliambulanza Hospital, Via Leonida Bissolati 57, 25125 Brescia, Italy
cch-segreteria.poli{at}poliambulanza.it

OBJECTIVE: To identify the effects of the time between myocardial infarction and surgery, the site of infarction, mitral involvement on ventricular geometry, and clinical outcome in the treatment of ischemic cardiomyopathy in patients with heart failure.

METHODS: Sixty-nine consecutive patients with ischemic cardiomyopathy, indexed end-systolic volume 50 mL/m², ejection fraction 35%, and heart failure underwent surgery 81.9 ± 100.8 months after myocardial infarction, using different techniques of ventricular restoration. Thirteen geometric parameters were studied pre- and postoperatively. Paired and unpaired t tests and general linear model for multivariate analysis were used to analyze subgroups. Logistic regression and Kaplan-Meier survival curves with pairwise log-rank were used to correlate covariates to clinical outcome.

RESULTS: Longer time to surgery and posterior necrosis linearly correlated with higher left ventricular volumes (r² = .66) and diameters (r² = .40). High grade of mitral regurgitation was always present in posterior infarctions. Hospital mortality was 4.3%. Complicated postoperative course was predicted by mitral surgery (P = .004) and longer time to surgery (P = .04). Survival was significantly lower in the posterior infarction (P = .0002) and mitral surgery (P = .001) subgroups. At a mean follow-up of 1.9 ± 1.3 years, functional status and geometrical restoration are influenced by the studied covariates.

CONCLUSIONS: Longer time to surgery after myocardial infarction, its posterior location, and significant mitral regurgitation can affect left ventricular remodeling, surgical restoration, and clinical outcome in patients with ischemic cardiomyopathy.

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