title: Surgical ventricular restoration plus mitral valve repair in patients with ischaemic heart failure: risk factors for early and mid-term outcomes†.
abstract: OBJECTIVE
  To assess the early and mid-term outcomes and related predictors in a consecutive series of patients who underwent surgical ventricular restoration (SVR) combined with additional mitral valve (MV) repair.
  
  
  METHODS
  From January 2001 to October 2014, 626 patients underwent SVR; of these, 175 (28%, median age 65) had an additional MV repair. Anterior, inferior or diffuse remodelling was present in 124 (71%), 41 (23%) and 10 (6%) patients, respectively. The median ejection fraction was 30%, whereas mitral regurgitation grade was 3.3 ± 0.8. Multivariable logistic regression and Cox regression analyses were used to identify predictors of early and mid-term mortality.
  
  
  RESULTS
  Operative death occurred in 25 patients (14.3%). Independent predictors of early mortality were age, creatinine and ejection fraction score [odds ratio (OR) = 5.1, 95% confidence interval (CI) 2.5-10.3], previous stroke (OR = 8.0, 95% CI 1.5-44), unstable angina (OR = 8.8, 95% CI 1.5-53) and diffuse remodelling (OR = 5.8, 95% CI 1.02-33). Average follow-up was 42 ± 37 months. The actuarial survival rate of the whole patient population at 3, 5 and 8 years was 72 ± 4, 65 ± 4 and 45 ± 6%, respectively. Risk factors for late mortality were preoperative creatinine (OR = 2.6, 95% CI 1.5-4.4), previous implantation of cardioverter defibrillator (OR = 4.7, 95% CI 1.6-5.8), whereas the absence of angina at the time of surgery emerged as protective factor (OR = 0.46, 95% CI 0.23-0.89).
  
  
  CONCLUSIONS
  MV repair combined with SVR is a complex and challenging procedure that can be performed with acceptable early and mid-term results. Interestingly, angina features predict both early and late outcome, with unstable angina at the time of surgery being a predictor of poor early outcome and the absence of angina at surgery, a predictor of favourable outcome at mid-term follow-up.
authors.affiliation: Department of Cardiac Surgery, I.R.C.C.S., Policlinico San Donato, Milan, Italy castelvecchio.serenella@gmail.com.
authors.forename: Serenella
authors.initials: S
authors.lastname: Castelvecchio
authors.affiliation: Department of Cardiac Surgery, I.R.C.C.S., Policlinico San Donato, Milan, Italy Department of Biomedical Science, University of Milan, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Parolari
authors.affiliation: Department of Cardiac Surgery, I.R.C.C.S., Policlinico San Donato, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Garatti
authors.affiliation: Department of Cardiac Surgery, I.R.C.C.S., Policlinico San Donato, Milan, Italy.
authors.forename: Piervincenzo
authors.initials: P
authors.lastname: Gagliardotto
authors.affiliation: Department of Cardiac Surgery, I.R.C.C.S., Policlinico San Donato, Milan, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Mossuto
authors.affiliation: Department of Cardiac Surgery, I.R.C.C.S., Policlinico San Donato, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Canziani
authors.affiliation: Department of Cardiac Surgery, I.R.C.C.S., Policlinico San Donato, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Menicanti
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Heart failure; Outcome; Surgical ventricular restoration