Abstract
ObjectiveTo report our center’s experience in the surgical treatment of ventricular reconstruction, an effective and efficient technique that allows patients with end-stage heart failure of ischemic etiology to have clinical improvement and increased survival.MethodsObservational, clinical-surgical, sequential, retrospective study. Patients with ischemic cardiomyopathy and left ventricular aneurysm were attended at the Heart Failure, Ventricular Dysfunction and Cardiac Transplant outpatient clinic of the Dante Pazzanese Cardiology Institute, from January 2010 to December 2016. Data from 34 patients were collected, including systemic arterial hypertension, ejection fraction, New York Heart Association (NYHA) functional classification (FC), European System for Cardiac Operative Risk Evaluation (EuroSCORE) II value, Society of Thoracic Surgeons (STS) score, ventricular reconstruction technique, and survival.ResultsOverall mortality of 14.7%, with hospital admission being 8.82% and late death being 5.88%. Total survival rate at five years of 85.3%. In the preoperative phase, NYHA FC was Class I in five patients, II in 18, III in eight, and IV in three vs. NYHA FC Class I in 17 patients, II in eight, III in six, and IV in three, in the postoperative period. EuroSCORE II mean value was 6.29, P≤0.01; hazard ratio (HR) 1.16 (95% confidence interval [CI] 1.02-1.31). STS mortality/morbidity score mean value was 18.14, P≤0.004; HR 1.19 (95% CI 1.05-1.33). Surgical techniques showed no difference in survival among Dor 81% vs. Jatene 91.7%.ConclusionSurgical treatment of left ventricular reconstruction in candidates for heart transplantation is effective, efficient, and safe, providing adequate survival.
Highlights
When we evaluate the possibilities of treatment of these patients, they range from the prevention of reversible factors, such as Coronary artery disease (CAD) and hyperthyroidism, to clinical treatment that includes pharmacological and non-pharmacological strategies, cardiac resynchronization therapy and cardiac defibrillator implantation, and in the final stage of heart failure (HF), the use of circulatory assistance devices as a bridge to heart transplantation (HTx) or as target therapy[3], all of these when optimized can preserve the quality of life and survival of these patients
Other patients benefit from conventional surgical treatment aimed at myocardial revascularization (MR), isolated and/or concomitant with the treatment of dilation of the left ventricular cavity, secondary to the formation of areas of akinesia or aneurysm[4], as well as to the treatment of mitral regurgitation, resulting from ventricular remodeling due to chronic ischemia
The search for more scientifically consistent information led to multicenter studies, such as that developed by the RESTORE group[11], which achieved a five-year survival rate of 68.6%, with improvement of the preoperative functional classification (FC) of 67% in class III-IV and 85% in postoperative functional class I-II
Summary
Coronary artery disease (CAD), whose clinical manifestations are angina pectoris, acute myocardial infarction (AMI), sudden death, or ischemic cardiomyopathy, is the leading cause of death in Brazil, according to the Information Technology Department of the Brazilian Public Health Care System (DATASUS)[1]. The surgical ventricular reconstruction (SVR) is a procedure used to treat advanced HF caused by systolic dysfunction and ventricular dilatation after AMI. It aims to reduce the volume and restore the ventricular shape of the heart[3]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
