Left ventricular surgical restoration for anteroseptal scars: volume versus shape

J Thorac Cardiovasc Surg. 2010 May;139(5):1123-30. doi: 10.1016/j.jtcvs.2010.01.001.


Objective: We report the long-term results of left ventricular surgical restoration in which 2 different strategies were used, which had restoration of ventricular volume or ventricular shape as their target.

Methods: From 1988 to 2008, 308 patients with anterior scars underwent elective left ventricular surgical restoration. Before 2002, a Dor procedure was performed in 107 cases to reduce left ventricular volume (group V); from 1998 to 2001, a Guilmet procedure was performed in 32 patients to rebuild a left ventricular conical shape (group S). From 2002, 169 patients (group S) underwent left ventricular surgical restoration to reshape a conical left ventricle by means of the Dor procedure (n = 29, septoapical scars) or septal reshaping (n = 140, when the septum was more involved than the anterior wall). The 2 groups were similar for all features but age, mitral regurgitation grade, mitral valve surgery rate (higher in group S), and ejection fraction (higher in group V).

Results: Early mortality was 7.8% (11.2% in group V vs 6.0% in group S, P = .102). Logistic regression showed that volume reduction was significantly related to higher early mortality. Five-year cardiac survival, cardiac event-free survival, and event-free survival were higher in group S. Cox analysis showed that the choice of volume reduction provided lower survival (hazard ratio, 2.1), cardiac survival (hazard ratio, 3.0), cardiac event-free survival (hazard ratio, 2.7), and event-free survival (hazard ratio, 2.2). When 30-day events were excluded, volume reduction was still a risk factor for cardiac event-free survival (hazard ratio, 2.2).

Conclusions: When the main target of left ventricular surgical restoration is left ventricular reshaping rather than left ventricular volume reduction, early and late outcomes seem to improve.

MeSH terms

  • Aged
  • Anterior Wall Myocardial Infarction / diagnostic imaging
  • Anterior Wall Myocardial Infarction / mortality
  • Anterior Wall Myocardial Infarction / pathology
  • Anterior Wall Myocardial Infarction / surgery*
  • Cardiac Surgical Procedures / adverse effects
  • Cardiac Surgical Procedures / methods*
  • Cardiac Surgical Procedures / mortality
  • Chi-Square Distribution
  • Disease-Free Survival
  • Female
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / pathology
  • Heart Ventricles / surgery*
  • Humans
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Middle Aged
  • Myocardium / pathology*
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Ultrasonography
  • Ventricular Dysfunction, Left / diagnostic imaging
  • Ventricular Dysfunction, Left / mortality
  • Ventricular Dysfunction, Left / pathology
  • Ventricular Dysfunction, Left / surgery*