Document Detail


Long-term results and mid-term features of left ventricular reconstruction procedures on left ventricular volume, geometry, function and mitral regurgitation.
MedLine Citation:
PMID:  22886788     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVES: We retrospectively analysed the long-term results and mid-term features of the surgical procedures on left ventricular (LV) volume, geometry, function and mitral regurgitation (MR) in patients with ischaemic cardiomyopathy (antero-septal dominant) who underwent LV reconstruction (LVR).
METHODS: The LVR was mainly accomplished by the Dor procedure, modified by the Fontan stitch maintained by the base of the LV septum prior to the flattened-out elliptical patch closure. Other techniques such as the linear closure or septal anterior ventricular exclusion (SAVE) were used when indicated. Sixty patients were divided into three groups, undergoing LVR with the Dor procedure (n = 40), linear closure (n = 12) or SAVE (n = 8). The LV function, volume and sphericity (eccentricity index) were logged before the operation and 1 year after.
RESULTS: Survivors (79% at 7 years) showed a significant improvement in the LV ejection fraction from 35.1 ± 8.1 to 43.5 ± 11.5% and NYHA status from 2.9 ± 0.7 to 1.3 ± 0.6. The LV end-systolic volume index was significantly reduced from 110.3 ± 35.9 to 57.8 ± 20.7 ml/m(2) in the Dor, from 71.9 ± 10.3 to 52.9 ± 19.4 ml/m(2) in the linear closure and from 93.1 ± 14.5 to 47.9 ± 15.7 ml/m(2) in the SAVE group. The postoperative changes in the Dor group are characterized by the reduction in the significantly larger LV volume and a more spherical chamber (systolic eccentricity index from 0.82 ± 0.10 to 0.80 ± 0.09), although not significantly so compared with other techniques. The MR grade measured on echocardiography was reduced (from 1.9 ± 0.8 to 1.7 ± 0.8), with postoperative moderate MR in four Dor patients.
CONCLUSIONS: Despite the more spherical LV change, LVR led to a significant volume reduction (45%), still maintaining its physiological shape that confirmed an improved LV function and better long-term results. The Dor procedure could significantly reduce the larger LV volume without losing the end-systolic elliptical shape and mitral valvular competence like other techniques without the Fontan stitch.
Authors:
Yasunori Cho; Toshihiko Ueda; Yoshito Inoue; Shinichiro Shimura; Akira Aki; Hidekazu Furuya; Kimiaki Okada; Chiharu Tanaka
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  42     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  462-9     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Surgery, Tokai University School of Medicine, Isehara, Japan.
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