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Reviews

Early and late outcome of left ventricular reconstruction surgery in ischemic heart disease

^a Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
^b Atlanta Cardiovascular Research Institute, Atlanta, GA, USA
^c Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

Received 4 March 2008; received in revised form 26 June 2008; accepted 27 June 2008.

^_* Corresponding author. Address: Department of Cardiothoracic Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. Tel.: +31 71 5264022; fax: +31 71 5266965. (Email: r.j.m.klautz{at}lumc.nl).

A systematic review of the literature was performed to determine early and late mortality associated with left ventricular (LV) reconstruction surgery and to assess the influence of different surgical techniques, concomitant surgical procedures, clinical and hemodynamic parameters on mortality. The MEDLINE database (January 1980–January 2005) was searched and from the pooled data, hospital mortality and survival were calculated. Summary estimates of relative risks (RR) were calculated for the techniques that were used and for concomitant coronary artery bypass grafting (CABG) and mitral valve surgery. The risk-adjusted relationships between mortality and clinical and hemodynamic parameters were assessed by meta-regression. A total of 62 studies (12,331 patients) were identified. Weighted average early mortality was 6.9%. Cumulative 1-year, 5-year and 10-year survival were 88.5%, 71.5% and 53.9%, respectively. Endoventricular reconstruction (EVR) showed a reduced risk for both early (RR = 0.79, p < 0.005) and late (RR = 0.67, p < 0.001) mortality compared to the linear repair (early: RR = 1.38, p < 0.001; late: RR = 1.83, p < 0.001). Early and late mortality were mainly cardiac in origin, with as predominant cause heart failure in respectively 49.7% and 34.5% of the cases. Ventricular arrhythmias caused 16.6% of early deaths and 17.2% of late deaths. Concomitant CABG significantly decreased late mortality (RR = 0.28, p < 0.001) without increasing early mortality (RR = 1.018, p = 0.858). Concomitant mitral valve surgery showed both an increased risk for early (RR = 1.57, p = 0.001) and late mortality (RR = 4.28, p < 0.001). No clinical or hemodynamic parameters were found to influence mortality. It is noteworthy that only one third of patients included in the current analysis were operated for heart failure (14 studies, 4135 patients). In this group we noted an early mortality of 11.0% with a late mortality (3-year) of 15.2%. This analysis of pooled literature data showed that LV reconstruction surgery is performed with acceptable mortality and EVR may be the preferred technique with a reduced risk for early and late mortality. Concomitant CABG improved outcome, whereas the need for mitral valve surgery appeared an index of gravity. No clinical or hemodynamic parameters were found to influence mortality; specifically LV ejection fraction and LV volumes both did not predict outcome.

Key Words: Left ventricular reconstruction surgery • Aneurysmectomy • Surgical ventricular restoration • Dor procedure • Ischemic heart disease • Heart failure

This article has been cited by other articles:

				S. Castelvecchio, M. Ranucci, and L. A. Menicanti The role of surgical technique in determining the outcome of left ventricular reconstruction: a difficult assessment Eur. J. Cardiothorac. Surg., June 1, 2009; 35(6): 1111 - 1111. [Full Text] [PDF]

				P. Klein, J. J. Bax, and R. J.M. Klautz Reply to Castelvecchio et al. Eur. J. Cardiothorac. Surg., June 1, 2009; 35(6): 1111 - 1112. [Full Text] [PDF]

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