TY - JOUR
T1 - Early and late outcome of left ventricular reconstruction surgery in ischemic heart disease
AU - Klein, Patrick
AU - Bax, Jeroen J.
AU - Shaw, Leslee J.
AU - Feringa, Harm H. H.
AU - Versteegh, Michel I. M.
AU - Dion, Robert A. E.
AU - Klautz, Robert J. M.
PY - 2008
Y1 - 2008
N2 - 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. © 2008 European Association for Cardio-Thoracic Surgery.
AB - 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. © 2008 European Association for Cardio-Thoracic Surgery.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=55949125558&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/18760619
U2 - https://doi.org/10.1016/j.ejcts.2008.06.045
DO - https://doi.org/10.1016/j.ejcts.2008.06.045
M3 - Review article
C2 - 18760619
SN - 1010-7940
VL - 34
SP - 1149
EP - 1157
JO - European journal of cardio-thoracic surgery
JF - European journal of cardio-thoracic surgery
IS - 6
ER -