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J Thorac Cardiovasc Surg 2007;134:280-283
© 2007 The American Association for Thoracic Surgery

Editorial

The effect of preoperative diastolic dysfunction on outcome after surgical ventricular remodeling

^a Department of Surgery,University of California, San Francisco, California
^b Department of Bioengineering, University of California, San Francisco, California
^c Department of Veterans Affairs Medical Center, San Francisco, California.

Received for publication January 20, 2007; accepted for publication January 31, 2007.

^_* Reprint requests: Mark B. Ratcliffe, MD, Division of Surgical Services (112D), San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121. (Email: Mark.Ratcliffe@med.va.gov).

The first 300 words of the full text of this article appear below.

In this issue, Menicanti and colleagues¹ describe the experience with surgical ventricular restoration (SVR) procedures at the San Donato Hospital between 1989 and 2005. The study is important for a number of reasons. First, 1300 patients underwent SVR. This is the largest single-center experience to date, and the authors are to be commended for the excellent overall operative mortality of 4.7%.¹

A subgroup of 488 patients in Menicanti and colleagues’ study¹ had echocardiograms before, early after (7–10 days), and late after (6 months to 2 years) SVR. In 254 patients who have undergone operations since 2001, echocardiographic measures of diastolic function, including the early-to-late mitral valve flow ratio (E/A), isovolumic relaxation time, and deceleration time (DT) of early mitral flow (E wave), were collected.¹ Normally, early flow (E wave) is higher than that associated with atrial contraction (A wave). Early diastolic dysfunction is typically associated with a reversal of the E/A ratio.² However, as diastolic compliance worsens and left ventricular end-diastolic pressure increases, the E/A ratio becomes "pseudo-normalized."³ End-stage or restrictive diastolic dysfunction is associated with an E/A greater than 2. In Menicanti and colleagues’ study,¹ an E/A ratio greater than 2 was associated with early mortality after SVR. Isovolumic relaxation time and DT have also been associated with ventricular cavity stiffness; however, the effects of isovolumic relaxation time and DT were not statistically significant in Menicanti and colleagues’ study. This is the first time that severe diastolic dysfunction has been identified as a risk factor for SVR.

The effect of SVR on ventricular function and the related effect of diastolic dysfunction on outcome after SVR have not been well studied until recently. However, in September, 2006, an article by Tulner and colleagues⁴ and accompanying editorial by Burkhoff and Wechsler⁵ were published in the Journal. The study by Tulner and . . . [Full Text of this Article]

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

Lorenzo Menicanti, Serenella Castelvecchio, Marco Ranucci, Alessandro Frigiola, Carlo Santambrogio, Carlo de Vincentiis, Jelena Brankovic, and Marisa Di Donato
J. Thorac. Cardiovasc. Surg. 2007 134: 433-441. [Abstract] [Full Text] [PDF]