[Initial results of left ventricular remodelling operations].
The aim of our study was to evaluate the initial results of left ventricular CABG and left ventricular remodelling operations. Study group consisted of 47 patients (pts) who underwent left ventricular geometry and volume restoration operations at the Kaunas University of Medicine Hospital during 1996 to 2002. Protocol included general clinical data, NYHA functional class, pre- and postoperative echocardiographic data, left ventricular aneurysm repair procedures. Pts mean age was 63.4+/-1.2 years. Men/women ratio 38/9. At admission NYHA functional class was 3.5+/-0.1. Mean left ventricular ejection fraction preoperatively was 24.2+/-0.9%, LV end diastolic diameter - 60.3+/-1.2 mm. Correction of left ventricular aneurysm consisted of: 1) direct aneurysmectomy - 11 pts, 2) endoventricular patch plasty - 7 pts, 3) circular suture - 19 pts, 4) aneurysmal reinforcement - 10 pts.


RESULTS
Early postoperative NYHA functional class decreased from 3.5+/-0.1 to 2.8+/-0.1 (p<0.0001) and late postoperative to 2.7+/-0.2 (p<0.0001). Within 2 weeks LV morphometric parameters, left ventricular ejection fraction, mean pulmonary artery pressure didn't change significantly. There was a significant reduction of mitral regurgitation in all survivals from grade 2.5+/-0.1 to 1.4+/-0.2 (p<0.0001). Hospital mortality - 25.5%, late mortality - 22.2%. Late postoperative LV end diastolic and systolic diameters had a tendency to increase. All of the patients showed late postoperative increase in deceleration time from 0.13+/-0.01 to 0.18+/-0.02 s (p<0.05), decrease in degree of MR from 2.6+/-0.1 to 1.8+/-0.3 (p<0.05). LV systolic function has a tendency to increase from 25.6+/-1.4 to 29.1+/-1.4. In conclusion, effective LV surgical remodelling combined with CABG improves pts functional status: NYHA functional class, LV diastolic function. But the results of these combined cardiac operations are not so excellent. The hospital mortality remains high, correction of LV morphometric parameters is not preferable.
Benetis
Rimantas
R
Clinic of Cardiac Surgery, Kaunas University of Medicine Hospital, Eiveniu 2, 3007 Kaunas, Lithuania.
Jankauskiene
Loreta
L
Vaskelyte
Jolanta
J
D000328:Adult; D000368:Aged; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006322:Heart Aneurysm / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000503:physiopathology; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D020257:Ventricular Remodeling