Surgical ventricular restoration for patients with ischemic heart failure: determinants of two-year survival.
BACKGROUND
Surgical ventricular restoration (SVR) improves left ventricular (LV) systolic function by partially restoring the normal geometry of the left ventricle. However, the beneficial effects of this surgical procedure on long-term clinical outcome remain controversial. The present study aimed to evaluate the independent determinants of 2-year morbidity and mortality rates after SVR.


METHODS
Seventy-nine patients with ischemic heart disease and LV ejection fraction of 0.35 or less were included. All patients underwent SVR and additionally coronary artery bypass grafting or mitral valve surgery if clinically indicated. Clinical and echocardiographic examination was performed before SVR and at 6 months' follow-up. The primary end point was a composite of all-cause mortality and hospitalizations for heart failure.


RESULTS
At 6 months' follow-up a significant improvement in heart failure symptoms was noted. In addition, LV ejection fraction increased from 0.27 ± 0.07 to 0.36 ± 0.10 (p < 0.001). During a median follow-up of 2.7 years, the primary end point was recorded in 22% of the patients. Baseline New York Heart Association functional class IV and a 6-month follow-up LV end-systolic volume index of at least 60 mL/m(2) were independently associated with worse outcome (hazard ratio, 5.4; 95% confidence interval, 1.9 to 15.2; p < 0.001; hazard ratio, 2.7; 95% confidence interval, 1.3 to 5.6; p < 0.001, respectively).


CONCLUSIONS
Advanced heart failure status at baseline and large residual postsurgery LV end-systolic volume index were independently associated with increased mortality and heart failure hospitalization rates at 2 years' follow-up after SVR.
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Tomasz G
TG
Witkowski
Ellen A
EA
ten Brinke
Victoria
V
Delgado
Arnold C T
AC
Ng
Matteo
M
Bertini
Nina Ajmone
NA
Marsan
See H
SH
Ewe
Dominique
D
Auger
Kelvin H
KH
Yiu
Jerry
J
Braun
Patrick
P
Klein
Paul
P
Steendijk
Michel I M
MI
Versteegh
Robert J
RJ
Klautz
Jeroen J
JJ
Bax
D002423:Cause of Death; D015897:Comorbidity; D016001:Confidence Intervals; D003920:Diabetes Mellitus / Q000453:epidemiology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000401:mortality*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D013318:Stroke Volume; D015996:Survival Rate; D013599:Systole; D016896:Treatment Outcome