Beneficial hemodynamic and clinical effects of surgical ventricular restoration in patients with ischemic dilated cardiomyopathy.
BACKGROUND
Surgical ventricular restoration is increasingly applied in patients with ischemic dilated cardiomyopathy. Previous studies show promising results with regard to survival and clinical outcome. However, a comprehensive midterm analysis of this approach on left ventricular (LV) and right ventricular function is not yet available. We investigated biventricular function and clinical status at 6-month follow-up.


METHODS
We investigated the effects of surgical ventricular restoration on clinical variables, LV volume, right ventricular reverse remodeling, LV dyssynchrony, tricuspid regurgitation, and pulmonary artery pressure in 21 patients with ischemic dilated cardiomyopathy (New York Heart Association class III or IV) who underwent surgical ventricular restoration and coronary artery bypass grafting. Additional surgery included mitral annuloplasty (n = 14) and tricuspid valve annuloplasty (n = 8). Clinical variables (New York Heart Association class, quality-of-life questionnaire, 6-minute hall-walk test) and echocardiographic variables were assessed at baseline and at 6 months.


RESULTS
At 6-month follow-up, all clinical variables were significantly improved. Left ventricular ejection fraction improved from 0.27 +/- 0.10 to 0.36 +/- 0.11 (p < 0.01), LV end-diastolic volume decreased from 248 +/- 78 mL to 152 +/- 50 mL (p < 0.001), and LV end-systolic volume decreased from 186 +/- 77 mL to 101 +/- 50 mL (p < 0.001). Left ventricular dyssynchrony decreased from 61 +/- 41 ms to 12 +/- 12 ms (p < 0.001). Right ventricular annular diameter decreased from 30 +/- 7 mm to 27 +/- 6 mm, right ventricular short-axis from 30 +/- 9 mm to 27 +/- 7 mm, and right ventricular long-axis from 90 +/- 7 mm to 79 +/- 10 mm (all p < 0.05). Finally, significant reductions in severity of tricuspid regurgitation (from 1.3 +/- 1.1 to 0.9 +/- 0.6; p = 0.001) and pulmonary artery pressure (42 +/- 11 mm Hg to 28 +/- 10 mm Hg; p = 0.015) were observed.


CONCLUSIONS
Surgical ventricular restoration resulted in improvement of clinical variables, significant LV volume reduction, and reduced LV dyssynchrony at 6-month follow-up. In addition, right ventricular reverse remodeling was noted with reductions in tricuspid regurgitation and pulmonary artery pressure.
Tulner
Sven A F
SA
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Bax
Jeroen J
JJ
Bleeker
Gabe B
GB
Steendijk
Paul
P
Klautz
Robert J M
RJ
Holman
Eduard R
ER
Schalij
Martin J
MJ
Dion
Robert A E
RA
van der Wall
Ernst E
EE
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D001026:Coronary Artery Bypass; D005260:Female; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications*; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right