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Lorenzo Menicanti
Marco Ranucci
Alessandro Frigiola
Carlo de Vincentiis
Marisa Di Donato
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J Thorac Cardiovasc Surg 2007;134:433-441
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Surgical therapy for ischemic heart failure: Single-center experience with surgical anterior ventricular restoration

Lorenzo Menicanti, MDa,1, Serenella Castelvecchio, MDa, Marco Ranucci, MDa, Alessandro Frigiola, MDa, Carlo Santambrogio, MDa, Carlo de Vincentiis, MDa, Jelena Brankovic, MDa, Marisa Di Donato, MDb,1,*

a Cardiac Surgery Department, San Donato Hospital, Milano, Italy
b Critical Care Medicine Department, University of Florence, Florence, Italy.

Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29-May 3, 2006.

Received for publication June 13, 2006; revisions received November 13, 2006; accepted for publication December 1, 2006.

* Address for reprints: Marisa Di Donato, MD, Cardiac Surgery Department, San Donato Hospital, Via Morandi 30, San Donato Milanese, Milan, Italy. (Email: marad{at}tin.it).

Objectives: Our objectives were (1) to report operative and long-term mortality in patients submitted to anterior surgical ventricular restoration, (2) to report changes in clinical and cardiac status induced by surgical ventricular restoration, and (3) to report predictors of death in a large cohort of patients operated on at San Donato Hospital, Milan, Italy.

Methods: A total of 1161 consecutive patients (83% men, 62 ± 10 years) had anterior surgical ventricular restoration with or without coronary artery bypass grafting and with or without mitral repair/replacement. A complete echocardiographic study was performed in 488 of 1161 patients operated on between January 1998 and October 2005 (study group). The indication for surgery was heart failure in 60% of patients, angina, and/or a combination of the two.

Results: Thirty-day cardiac mortality was 4.7% (55/1161) in the overall group and 4.9% (24/488) in the study group. Determinants of hospital mortality were mitral valve regurgitation and need for a mitral valve repair/replacement. Mitral regurgitation (>2+) associated with a New York Heart Association class greater than II and with diastolic dysfunction (early-to-late diastolic filling pressure >2) further increases mortality risk. Global systolic function improved postoperatively: ejection fraction improved from 33% ± 9% to 40% ± 10% (P < .001); end-diastolic and end-systolic volumes decreased from 211 ± 73 to 142 ± 50 and 145 ± 64 to 88 ± 40 mL, respectively (P < .001) early after surgery. New York Heart Association functional class improved from 2.7 ± 0.9 to 1.6 ± 0.7 (P < .001) late after surgery. Long-term survival in the overall population was 63% at 120 months.

Conclusions: Surgical ventricular restoration for ischemic heart failure reduces ventricular volumes, improves cardiac function and functional status, carries an acceptable operative mortality, and results in good long-term survival. Predictors of operative mortality are mitral regurgitation of 2+ or more, New York Heart Association class greater than II, and diastolic dysfunction (early-to-late diastolic filling pressure >2).

Abbreviations and Acronyms AUC = area under the curve; CABG = coronary artery bypass grafting; E/A = early-to-late diastolic filling pressure; EF = ejection fraction; HF = heart failure; LV = left ventricular; MR = mitral regurgitation; NYHA = New York Heart Association; ROC = receiver operating characteristic; STICH = Surgical Treatment of IsChemic Heart failure (trial); SVR = surgical ventricular restoration


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The effect of preoperative diastolic dysfunction on outcome after surgical ventricular remodeling
Mark B. Ratcliffe and T. Sloane Guy
J. Thorac. Cardiovasc. Surg. 2007 134: 280-283. [Extract] [Full Text] [PDF]

Discussion
J. Thorac. Cardiovasc. Surg. 2007 134: 439-441. [Extract] [Full Text] [PDF]



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M. B. Ratcliffe and T. S. Guy
The effect of preoperative diastolic dysfunction on outcome after surgical ventricular remodeling
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