Estimating postoperative left ventricular volume: Identification of responders to surgical ventricular reconstruction

The Journal of Thoracic and Cardiovascular Surgery

Shuichiro Takanashi¹  Hitoshi Yaku²  Yoshikatsu Saiki³  Yasunori Cho⁴  Akihiko Usui⁵  Yoshiro Matsui⁶  Tatsuhiko Komiya⁷  Hideyuki Shimizu⁸  Tadashi Isomura⁹  Junjiro Kobayashi^1,10  Goro Matsumiya^1,11  Kimikazu Hamano^1,12  Satoru Wakasa^1,13  Atsushi Yamaguchi^1,14  Ryuzo Sakata^1,15  Yoshiki Sawa^1,16 

[1] Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan;Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan;Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan;Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan;Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan;Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan;Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan;Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan;Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan;Department of Cardiovascular Surgery, Tokai University School of Medicine, Isehara, Japan;Department of Cardiovascular Surgery, Tokyo Heart Center, Tokyo, Japan;Department of Cardiovascular Surgery, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan;Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan;Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan;Division of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan;Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan

关键词: surgical ventricular reconstruction;    ischemic cardiomyopathy;    coronary artery bypass grafting;    responder;   

DOI  :  10.1016/j.jtcvs.2018.06.090

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectivesThe postoperative left ventricular end-systolic volume index and ejection fraction are benchmarks of surgical ventricular reconstruction but remain unpredictable. This study aimed to identify who could be associated with a higher long-term survival by adding surgical ventricular reconstruction to coronary artery bypass grafting than coronary artery bypass grafting alone (responders to surgical ventricular reconstruction).MethodsThe subjects were 293 patients (median age, 63 years; 255 men) who underwent coronary artery bypass grafting for ischemic heart disease with left ventricular dysfunction in 16 cardiovascular centers in Japan. The relationships among surgical ventricular reconstruction, postoperative end-systolic volume index, ejection fraction, and survival were analyzed to identify responders to surgical ventricular reconstruction.ResultsSurgical ventricular reconstruction was performed in 165 patients (56%). The end-systolic volume index and ejection fraction significantly improved (end-systolic volume index, 91 to 64 mL/m2; ejection fraction, 28% to 35%) for all patients. The postoperative end-systolic volume index and ejection fraction were estimated, and surgical ventricular reconstruction was found to be significantly associated with both end-systolic volume index (14.5 mL/m2 reduction, P P = .003). During the median follow-up of 6.8 years, 69 patients (24%) died. Only the postoperative ejection fraction was significantly associated with survival (hazard ratio, 0.925; 95% confidence interval, 0.885-0.968), although this effect was limited to those with postoperative end-systolic volume index of 40 to 80 mL/m2 in the subgroup analysis (hazard ratio, 0.932; 95% confidence interval, 0.894-0.973).ConclusionsAdding surgical ventricular reconstruction to coronary artery bypass grafting could reduce the mortality risk by increasing ejection fraction for those with a postoperative end-systolic volume index within a specific range. The postoperative end-systolic volume index could demarcate responders to surgical ventricular reconstruction, and its estimation can help in surgical decision making.

【 授权许可】

Unknown