title: Surgical ventricular restoration: is there any difference in outcome between anterior and posterior remodeling?
abstract: BACKGROUND
  The purpose of this study was to compare the early and long-term outcomes in a consecutive population who underwent surgical ventricular reconstruction (SVR) for either anterior or posterior remodeling.
  
  
  METHODS
  Among 501 consecutive patients who underwent SVR at our institution between July 2001 and December 2011, 56 patients presented with posterior remodeling (group A; mean age, 65 ± 10 years), whereas anterior remodeling was evident in 445 patients (group B; mean age, 65 ± 9 years). The 2 groups were comparable regarding cardiac risk factors and comorbidities. Patients in group A presented with larger left ventricles, higher left ventricular (LV) cardiac mass, and higher ejection (EF) and stroke volume (p = 0.01) compared with patients in group B. Moderate to severe mitral regurgitation was present in 50% and 25% of patients in groups A and B, respectively (p = 0.01).
  
  
  RESULTS
  Thirty-day mortality was not significantly different between the 2 groups (5.4% versus 8.3% in groups A and B, respectively; p = 0.32). At logistic regression analysis, only preoperative age, creatinine, and ejection fraction (ACEF) score was an independent predictor of early mortality. Sixteen patients (29%) in group A and 92 patients (21%) in group B died during follow-up (p = 0.12). Kaplan-Meier cumulative survival was comparable between the 2 groups (log-rank p = 0.27). At multivariate Cox regression analysis, preoperative age, advanced New York Heart Association (NYHA) class, preoperative severe mitral regurgitation (MR), and preoperative tricuspid annular plane systolic excursion (TAPSE) score less than 16 were independent predictors of late mortality.
  
  
  CONCLUSIONS
  Patients presenting with posterior remodeling showed worse clinical signs of angina and congestive heart failure (CHF) and a higher proportion of moderate to severe MR; however in the present experience early and long-term outcomes after SVR seemed to be unaffected by remodeling location.
authors.affiliation: Department of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato-San Donato Milanese, Milan, Italy. Electronic address: andrea.garatti@grupposandonato.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Garatti
authors.affiliation: Department of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato-San Donato Milanese, Milan, Italy.
authors.forename: Serenella
authors.initials: S
authors.lastname: Castelvecchio
authors.affiliation: Heart Failure Unit, I.R.C.C.S. Policlinico San Donato-San Donato Milanese, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bandera
authors.affiliation: Heart Failure Unit, I.R.C.C.S. Policlinico San Donato-San Donato Milanese, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Guazzi
authors.affiliation: Department of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato-San Donato Milanese, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Menicanti
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006352:Heart Ventricles / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D020257:Ventricular Remodeling