title: Impact of left ventricular remodelling on outcomes after left ventriculoplasty for ischaemic cardiomyopathy: Japanese surgical ventricular reconstruction group experience.
abstract: OBJECTIVE
  Surgical ventricular reconstruction (SVR) for patients with severe left ventricular (LV) remodelling due to ischaemic cardiomyopathy is still controversial, because the Surgical Treatment for Ischaemic Heart Failure (STICH) trial demonstrated that SVR not only has no beneficial effect on survival compared with coronary artery bypass grafting (CABG) alone, but also is worse for those with a larger LV. Therefore, we assessed the impact of LV remodelling on the outcomes after SVR for ischaemic cardiomyopathy in Japan, using Di Donato's LV shape classification.
  
  
  METHODS
  From 2000 to 2010, 627 patients underwent SVR for ischaemic heart failure in 11 Japanese hospitals. To assess the patients with an LV ejection fraction (LVEF) of ≤ 35% like the STICH trial, considering the severity of LV remodelling, the patients with a preoperative LVEF of >35%, no preoperative LV volume assessment and no preoperative LV shape classification were excluded. Finally, 323 patients were selected as the study subjects. The LV shape was divided into three types according to Di Donato's classification. Types 1 and 3 indicate the aneurysmal and globally akinetic LV, respectively. Type 2 is the intermediate shape.
  
  
  RESULTS
  Type 1, 2 and 3 LV shapes were observed in 85 (26%), 104 (32%) and 134 (42%) of the patients, respectively. The preoperative LV volume and diameter increased if the LV became more akinetic (Type 3 > 2 > 1, P < 0.001). LVEF was lower in those with more akinetic LV (P = 0.002). The preoperative LV end-diastolic volume index and LVEF in Type 3 patients were 133 ± 47 ml/m(2) and 22 ± 7%, respectively. Mitral valve repair was more frequently performed for patients with the Type 3 LV shape (65%) than for the others (P < 0.001). The hospital mortality rates were 2.4, 2.9 and 7.4% for Type 1, 2 and 3 patients, respectively (P = 0.16). Kaplan-Meier analysis demonstrated no significant difference in mortality among the three groups (log-rank P = 0.37). The 5-year survival rates were 81, 70 and 73% for Type 1, 2 and 3 patients, respectively.
  
  
  CONCLUSIONS
  The severity of LV remodelling did not affect survival after SVR plus CABG. The results of SVR were acceptable even for those with globally akinetic LV due to ischaemic cardiomyopathy.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Wakasa
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Matsui
authors.forename: Tadashi
authors.initials: T
authors.lastname: Isomura
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takanashi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamaguchi
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Komiya
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Cho
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yaku
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Kokaji
authors.forename: Hirokuni
authors.initials: H
authors.lastname: Arai
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D009202:Cardiomyopathies / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D005260:Female; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery; D017202:Myocardial Ischemia / Q000150:complications* / Q000401:mortality / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: Cardiomyoplasty; Dilated cardiomyopathy; Heart failure; Myocardial ischaemia; Myocardial revascularization