title: Left ventricular surgical remodelling: is it a matter of shape or volume?.
abstract: OBJECTIVE
  Left ventricular surgical remodelling (LVSR) can be targeted to volume reduction (VR), (independently of the final shape) or to conical shape (CS). The aim of this study was to evaluate the long-term clinical and echocardiographic results of these two surgical strategies.
  
  
  METHODS
  From January 1988 to December 2012, 401 patients underwent LVSR: 107 in Group VR (1988-2001) and 294 in Group CS (1998-2012). The latter group of patients had lower ejection fraction (EF) and higher mitral and tricuspid regurgitation grade, with higher incidence of pulmonary hypertension. A propensity score model was built to adjust long-term results for preoperative and operative profiles.
  
  
  RESULTS
  Thirty-day mortality was 6.0%. Median follow-up interval time was 100 (3-300) months. Overall 20-year and event-free survival were 36.1 ± 7.8 and 19.4 ± 7.2, respectively. No differences were found regarding 10-year survival (Group VR: 55.1 ± 4.8 vs Group CS: 64.2 ± 4.2, P = 0.16) and event-free survival (Group VR: 41.1 ± 4.8 vs Group CS: 50.5 ± 4.8, P = 0.12). However, Group CS provided better 10-year freedom from cardiac deaths (74.5 ± 3.7 vs 60.4 ± 4.8, P = 0.03) and from cardiac events (55.6 ± 5.0 vs 45.0 ± 4.9, P = 0.04). After propensity score adjustment, all the main outcomes were significantly better in Group CS. Multivariate Cox analysis confirmed this result; furthermore, to avoid any bias related to improved experience, 30-day mortality being higher in Group VR, we excluded the first month from Cox analysis: left ventricle VR (independently of the final shape) was still confirmed as the wrong approach. At the follow-up, Group CS showed significant improvement in EF (+18 vs +8%), end-systolic volume index (-35 vs -20%) and sphericity index (-6 vs +9%).
  
  
  CONCLUSIONS
  LVSR should aim to provide a more physiological shape (conical) rather than simple VR.
authors.affiliation: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia Department of Cardiology, University of L'Aquila, L'Aquila, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Di Mauro
authors.affiliation: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Angela L
authors.initials: AL
authors.lastname: Iacò
authors.affiliation: Department of Cardiology, University of L'Aquila, L'Aquila, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Bencivenga
authors.affiliation: Department of Cardiology, University of L'Aquila, L'Aquila, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Clemente
authors.affiliation: Department of Cardiology, University of L'Aquila, L'Aquila, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Marcon
authors.affiliation: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Mahmood
authors.initials: M
authors.lastname: Asif
authors.affiliation: Department of Cardiology, University of L'Aquila, L'Aquila, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Di Saverio
authors.affiliation: Department of Cardiology, University of L'Aquila, L'Aquila, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Romano
authors.affiliation: Department of Clinical Science and Bioimaging, University of Chieti, Chieti, Italy.
authors.forename: Sabina
authors.initials: S
authors.lastname: Gallina
authors.affiliation: Department of Cardiology, University of L'Aquila, L'Aquila, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Penco
authors.affiliation: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia am.calafiore@gmail.com.
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Calafiore
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D002306:Cardiac Volume; D004452:Echocardiography / Q000379:methods; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000601:surgery*; D020257:Ventricular Remodeling / Q000502:physiology*
keywords: Akinesia; Left ventricular remodelling; Left ventricular reshaping; Surgical ventricular restoration