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Effect of preoperative left ventricular diastolic dysfunction on mid-term outcomes after surgical ventricular restoration for ischemic cardiomyopathy

General Thoracic and Cardiovascular Surgery volume 65, pages 381–387 (2017)Cite this article

Abstract

Objectives

The impact of surgical ventricular restoration (SVR) on survival and major adverse cardiac events (MACEs) is still controversial. The purposes of this study were to analyze our surgical experience with SVR for ischemic cardiomyopathy and to determine the effect of preoperative left ventricular diastolic dysfunction on mid-term outcomes after SVR.

Methods and results

Between April 2010 and May 2016, 19 patients underwent SVR. The mean age was 60 ± 11 years and the mean New York Heart Association functional class was 2.9 ± 0.8. Preoperative mean left ventricular end systolic volume index (LVESVI) and ejection fraction (LVEF) were 134 ± 56 mL/m2 and 24 ± 7%, respectively. The early-to-late mitral valve flow ratio (E/A) on echocardiogram was 2.4 ± 1.8 and 9 patients had E/A ≥2, excluding 2 patients with atrial fibrillation. The mean follow-up period was 29 ± 16 months. One patient died of heart failure at 6 months postoperative; the overall survival rate at 3 years was 95%. MACEs requiring hospitalization occurred in 10 patients; E/A ≥2, or restrictive filling pattern, was the only significant predictor of MACE in multivariate analysis. Reverse remodeling was associated with E/A <2, but not E/A ≥2. There was also a significant difference between patients with E/A <2 vs. ≥2 with respect to MACE-free survival rates at 3 years (100 vs. 10%; p = 0.001).

Conclusion

The degree of preoperative diastolic dysfunction can influence the outcome after SVR. Patients with E/A ≥2 may not be good candidates for SVR.

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Fig. 1

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Acknowledgements

We would like to thank Editage (http://www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Japan

    Koji Furukawa, Mitsuhiro Yano, Masakazu Matsuyama, Masanori Nishimura & Katsuya Kawagoe

  2. Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki-city, Miyazaki, 889-1692, Japan

    Koji Furukawa, Eisaku Nakamura & Kunihide Nakamura

Authors
  1. Koji Furukawa
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  2. Mitsuhiro Yano
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  3. Eisaku Nakamura
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  4. Masakazu Matsuyama
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  5. Masanori Nishimura
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  6. Katsuya Kawagoe
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  7. Kunihide Nakamura
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Correspondence to Koji Furukawa.

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The authors declare that they have no conflict of interest.

Additional information

Presented at The 69th Annual Scientific Meeting of The Japanese Association for Thoracic Surgery.

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Furukawa, K., Yano, M., Nakamura, E. et al. Effect of preoperative left ventricular diastolic dysfunction on mid-term outcomes after surgical ventricular restoration for ischemic cardiomyopathy. Gen Thorac Cardiovasc Surg 65, 381–387 (2017). https://doi.org/10.1007/s11748-017-0773-1

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  • DOI: https://doi.org/10.1007/s11748-017-0773-1

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