title: Effect of preoperative left ventricular diastolic dysfunction on mid-term outcomes after surgical ventricular restoration for ischemic cardiomyopathy.
abstract: OBJECTIVE
  The impact of surgical ventricular restoration (SVR) on survival and major adverse cardiac events (MACEs) is still controversial. The purposes of this study were to analyze our surgical experience with SVR for ischemic cardiomyopathy and to determine the effect of preoperative left ventricular diastolic dysfunction on mid-term outcomes after SVR.
  
  
  RESULTS
  Between April 2010 and May 2016, 19 patients underwent SVR. The mean age was 60 ± 11 years and the mean New York Heart Association functional class was 2.9 ± 0.8. Preoperative mean left ventricular end systolic volume index (LVESVI) and ejection fraction (LVEF) were 134 ± 56 mL/m2and 24 ± 7%, respectively. The early-to-late mitral valve flow ratio (E/A) on echocardiogram was 2.4 ± 1.8 and 9 patients had E/A ≥2, excluding 2 patients with atrial fibrillation. The mean follow-up period was 29 ± 16 months. One patient died of heart failure at 6 months postoperative; the overall survival rate at 3 years was 95%. MACEs requiring hospitalization occurred in 10 patients; E/A ≥2, or restrictive filling pattern, was the only significant predictor of MACE in multivariate analysis. Reverse remodeling was associated with E/A <2, but not E/A ≥2. There was also a significant difference between patients with E/A <2 vs. ≥2 with respect to MACE-free survival rates at 3 years (100 vs. 10%; p = 0.001).
  
  
  CONCLUSIONS
  The degree of preoperative diastolic dysfunction can influence the outcome after SVR. Patients with E/A ≥2 may not be good candidates for SVR.
authors.affiliation: Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Japan. koji_furukawa@med.miyazaki-u.ac.jp.|Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki-city, Miyazaki, 889-1692, Japan. koji_furukawa@med.miyazaki-u.ac.jp.
authors.forename: Koji
authors.initials: K
authors.lastname: Furukawa
authors.affiliation: Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yano
authors.affiliation: Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki-city, Miyazaki, 889-1692, Japan.
authors.forename: Eisaku
authors.initials: E
authors.lastname: Nakamura
authors.affiliation: Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Matsuyama
authors.affiliation: Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Nishimura
authors.affiliation: Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Kawagoe
authors.affiliation: Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki-city, Miyazaki, 889-1692, Japan.
authors.forename: Kunihide
authors.initials: K
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000601:surgery*; D057234:Preoperative Period; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: E/A; Ischemic cardiomyopathy; Preoperative left ventricular diastolic dysfunction; Surgical ventricular restoration