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| Surgical Ventricular Restoration for Anteroseptal Scars. Volume or Shape? | |
Antonio M. Calafiore1, Angela L. Iacò1, Davide Amata1, Cataldo Castello1, Egidio Varone1, Fabio Falconieri1, Antonio Bivona1, Sabina Gallina2, Michele Di Mauro3; 1Cardiac Surgery, University of Catania, Catania, Italy; 2University of Chieti - Department of Cardiology, Chieti, Italy; 3University of Catania - Villa Bianca Hospital, Catania - Bari, Italy
Methods: From January 1988 to February 2008, 276 patients with anteroseptal scars underwent elective SVR. Before 2002 a Dor procedure was performed in 107 cases (favoring volume reduction, group A). From 2002, 169 patients underwent SVR to maintain a conical LV chamber (favoring shaping, group B); a Dor procedure (when the scar was septoapical) was used in 29 cases and septal reshaping (when the septum was more involved than the anterior wall) in 140. Preoperatively the 2 groups were similar but age (A 62±10 vs B 66±10 years, p=0.001), ejection fraction (EF) (A 38±10 vs B 33±8, p<0.001), mitral regurgitation grade (A 0.9±0.9 vs B 1.7±1.4, p<0.001) and mitral valve surgery (MVS) rate (A 22.4% vs B 46.2%, p<0.001). Late events included death any cause, NYHA Class III-IV and heart transplantation; cardiac events included cardiac death instead of death any cause. Results: Early mortality was 7.6%, 11.2% (A) versus 5.3% (B) (p=0.072). Logistic regression, adjusted for age, EF, and MVS showed that the choice of volume reduction (A) more than shape (B) was significantly related to higher early mortality (OR=5.1, p=0.002). Four-year freedom from any death was 79.2±2.5 (A 75.7±4.1 vs B 81.6±3.2, p=0.232), from cardiac death was 83.9±2.3 (A 78.3±4.0 vs B 87.6±2.8, p=0.037), from cardiac events was 72.9±2.9 (A 65.8±4.6 vs B 78.3±3.7, p=0.023) and from any event was 68.8±3.0 (A 63.6±4.7 vs B 72.7±3.8, p=0.117). Cox analysis, adjusted for age, EF and MVS showed that volume reduction rather than LV reshaping provided lower survival (HR=2.1, p=0.011), cardiac survival (HR=3.0, p<0.001), cardiac event-free survival (HR=2.7, p<0.001) and event-free survival (HR=2.2, p<0.001). Conclusion: Maintaining a conical ventricular shape provides better results when compared with pure volume reduction. Back to 2009 Annual Meeting Back to Program Outline Back to Main Program |
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