TY - JOUR
T1 - Beneficial Hemodynamic and Clinical Effects of Surgical Ventricular Restoration in Patients With Ischemic Dilated Cardiomyopathy
AU - Tulner, Sven A. F.
AU - Bax, Jeroen J.
AU - Bleeker, Gabe B.
AU - Steendijk, Paul
AU - Klautz, Robert J. M.
AU - Holman, Eduard R.
AU - Schalij, Martin J.
AU - Dion, Robert A. E.
AU - van der Wall, Ernst E.
PY - 2006
Y1 - 2006
N2 - Background: Surgical ventricular restoration is increasingly applied in patients with ischemic dilated cardiomyopathy. Previous studies show promising results with regard to survival and clinical outcome. However, a comprehensive midterm analysis of this approach on left ventricular (LV) and right ventricular function is not yet available. We investigated biventricular function and clinical status at 6-month follow-up. Methods: We investigated the effects of surgical ventricular restoration on clinical variables, LV volume, right ventricular reverse remodeling, LV dyssynchrony, tricuspid regurgitation, and pulmonary artery pressure in 21 patients with ischemic dilated cardiomyopathy (New York Heart Association class III or IV) who underwent surgical ventricular restoration and coronary artery bypass grafting. Additional surgery included mitral annuloplasty (n = 14) and tricuspid valve annuloplasty (n = 8). Clinical variables (New York Heart Association class, quality-of-life questionnaire, 6-minute hall-walk test) and echocardiographic variables were assessed at baseline and at 6 months. Results: At 6-month follow-up, all clinical variables were significantly improved. Left ventricular ejection fraction improved from 0.27 ± 0.10 to 0.36 ± 0.11 (p < 0.01), LV end-diastolic volume decreased from 248 ± 78 mL to 152 ± 50 mL (p < 0.001), and LV end-systolic volume decreased from 186 ± 77 mL to 101 ± 50 mL (p < 0.001). Left ventricular dyssynchrony decreased from 61 ± 41 ms to 12 ± 12 ms (p < 0.001). Right ventricular annular diameter decreased from 30 ± 7 mm to 27 ± 6 mm, right ventricular short-axis from 30 ± 9 mm to 27 ± 7 mm, and right ventricular long-axis from 90 ± 7 mm to 79 ± 10 mm (all p < 0.05). Finally, significant reductions in severity of tricuspid regurgitation (from 1.3 ± 1.1 to 0.9 ± 0.6; p = 0.001) and pulmonary artery pressure (42 ± 11 mm Hg to 28 ± 10 mm Hg; p = 0.015) were observed. Conclusions: Surgical ventricular restoration resulted in improvement of clinical variables, significant LV volume reduction, and reduced LV dyssynchrony at 6-month follow-up. In addition, right ventricular reverse remodeling was noted with reductions in tricuspid regurgitation and pulmonary artery pressure. © 2006 The Society of Thoracic Surgeons.
AB - Background: Surgical ventricular restoration is increasingly applied in patients with ischemic dilated cardiomyopathy. Previous studies show promising results with regard to survival and clinical outcome. However, a comprehensive midterm analysis of this approach on left ventricular (LV) and right ventricular function is not yet available. We investigated biventricular function and clinical status at 6-month follow-up. Methods: We investigated the effects of surgical ventricular restoration on clinical variables, LV volume, right ventricular reverse remodeling, LV dyssynchrony, tricuspid regurgitation, and pulmonary artery pressure in 21 patients with ischemic dilated cardiomyopathy (New York Heart Association class III or IV) who underwent surgical ventricular restoration and coronary artery bypass grafting. Additional surgery included mitral annuloplasty (n = 14) and tricuspid valve annuloplasty (n = 8). Clinical variables (New York Heart Association class, quality-of-life questionnaire, 6-minute hall-walk test) and echocardiographic variables were assessed at baseline and at 6 months. Results: At 6-month follow-up, all clinical variables were significantly improved. Left ventricular ejection fraction improved from 0.27 ± 0.10 to 0.36 ± 0.11 (p < 0.01), LV end-diastolic volume decreased from 248 ± 78 mL to 152 ± 50 mL (p < 0.001), and LV end-systolic volume decreased from 186 ± 77 mL to 101 ± 50 mL (p < 0.001). Left ventricular dyssynchrony decreased from 61 ± 41 ms to 12 ± 12 ms (p < 0.001). Right ventricular annular diameter decreased from 30 ± 7 mm to 27 ± 6 mm, right ventricular short-axis from 30 ± 9 mm to 27 ± 7 mm, and right ventricular long-axis from 90 ± 7 mm to 79 ± 10 mm (all p < 0.05). Finally, significant reductions in severity of tricuspid regurgitation (from 1.3 ± 1.1 to 0.9 ± 0.6; p = 0.001) and pulmonary artery pressure (42 ± 11 mm Hg to 28 ± 10 mm Hg; p = 0.015) were observed. Conclusions: Surgical ventricular restoration resulted in improvement of clinical variables, significant LV volume reduction, and reduced LV dyssynchrony at 6-month follow-up. In addition, right ventricular reverse remodeling was noted with reductions in tricuspid regurgitation and pulmonary artery pressure. © 2006 The Society of Thoracic Surgeons.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=33750090565&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/17062236
U2 - https://doi.org/10.1016/j.athoracsur.2006.05.050
DO - https://doi.org/10.1016/j.athoracsur.2006.05.050
M3 - Article
C2 - 17062236
SN - 0003-4975
VL - 82
SP - 1721
EP - 1727
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 5
ER -