title: Implication of right ventricular dysfunction on long-term outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction.
abstract: OBJECTIVE
  Whether right ventricular dysfunction affects clinical outcome after coronary artery bypass grafting with or without surgical ventricular reconstruction is still unknown. The aim of the study was to assess the impact of right ventricular dysfunction on clinical outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction.
  
  
  METHODS
  Of 1000 patients in the Surgical Treatment for Ischemic Heart Failure with coronary artery disease, left ventricular ejection fraction 35% or less, and anterior dysfunction, who were randomized to undergo coronary artery bypass grafting or coronary artery bypass grafting + surgical ventricular reconstruction, baseline right ventricular function could be assessed by echocardiography in 866 patients. Patients were followed for a median of 48 months. All-cause mortality or cardiovascular hospitalization was the primary end point, and all-cause mortality alone was a secondary end point.
  
  
  RESULTS
  Right ventricular dysfunction was mild in 102 patients (12%) and moderate or severe in 78 patients (9%). Moderate to severe right ventricular dysfunction was associated with a larger left ventricle, lower ejection fraction, more severe mitral regurgitation, higher filling pressure, and higher pulmonary artery systolic pressure (all P < .0001) compared with normal or mildly reduced right ventricular function. A significant interaction between right ventricular dysfunction and treatment allocation was observed. Patients with moderate or severe right ventricular dysfunction who received coronary artery bypass grafting + surgical ventricular reconstruction had significantly worse outcomes compared with patients who received coronary artery bypass grafting alone on both the primary (hazard ratio, 1.86; confidence interval, 1.06-3.26; P = .028) and the secondary (hazard ratio, 3.37; confidence interval, 1.36-8.37; P = .005) end points. After adjusting for all other prognostic clinical factors, the interaction remained significant with respect to all-cause mortality (P = .022).
  
  
  CONCLUSIONS
  Adding surgical ventricular reconstruction to coronary artery bypass grafting may worsen long-term survival in patients with ischemic cardiomyopathy with moderate to severe right ventricular dysfunction, which reflects advanced left ventricular remodeling.
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Disease, Medical University of Silesia, Zabrze, Poland. Electronic address: tomasz.kukulski@sccs.pl.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Kukulski
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Lilin
authors.initials: L
authors.lastname: She
authors.affiliation: Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Canada.
authors.forename: Normand
authors.initials: N
authors.lastname: Racine
authors.affiliation: Dedinje Cardiovascular Institute, Belgrade, Serbia.
authors.forename: Sinisa
authors.initials: S
authors.lastname: Gradinac
authors.affiliation: Westchester Medical Center, New York, NY.
authors.forename: Julio A
authors.initials: JA
authors.lastname: Panza
authors.affiliation: Duke Clinical Research Institute, Durham, NC; Department of Medicine-Cardiology, Duke University School of Medicine, Durham, NC.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.affiliation: University of Ottawa Heart Institute, Ottawa, Canada.
authors.forename: Kwan
authors.initials: K
authors.lastname: Chan
authors.affiliation: Glasgow Royal Infirmary, Glasgow, United Kingdom.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Petrie
authors.affiliation: Duke Clinical Research Institute, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC.
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Lee
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
authors.affiliation: Research Institute of Circulation Pathology, Novosibirsk, Russia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Romanov
authors.affiliation: Medical University of Silesia, Katowice, Poland.
authors.forename: Jolanta
authors.initials: J
authors.lastname: Biernat
authors.affiliation: Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Canada.
authors.forename: Jean L
authors.initials: JL
authors.lastname: Rouleau
authors.affiliation: Casa De Galicia, Montevideo, Uruguay.
authors.forename: Carmen
authors.initials: C
authors.lastname: Batlle
authors.affiliation: Medical University of Gdansk, Gdansk, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Rogowski
authors.affiliation: Ospedali Riuniti Di Bergamo, Bergamo, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Ferrazzi
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Disease, Medical University of Silesia, Zabrze, Poland.
authors.forename: Marian
authors.initials: M
authors.lastname: Zembala
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D016016:Proportional Hazards Models; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D020257:Ventricular Remodeling