Long-term effects of surgical ventricular restoration with additional restrictive mitral annuloplasty and/or coronary artery bypass grafting on left ventricular function: Six-month follow-up by pressure–volume loops

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 140; no. 6; pp. 1338 - 1344
• Main Authors: ten Brinke, Ellen A., MD, Klautz, Robert J., MD, PhD, Tulner, Sven A., MD, PhD, Verwey, Harriette F., MD, PhD, Bax, Jeroen J., MD, PhD, Schalij, Martin J., MD, PhD, van der Wall, Ernst E., MD, PhD, Versteegh, Michel I., MD, Dion, Robert A., MD, PhD, Steendijk, Paul, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.12.2010; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology. Vascular system; Cardiomyopathy, Dilated - diagnostic imaging; Cardiomyopathy, Dilated - physiopathology; Cardiomyopathy, Dilated - surgery; Cardiothoracic Surgery; Coronary Artery Bypass; Coronary heart disease; Diastole; Echocardiography; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Middle Aged; Mitral Valve - diagnostic imaging; Mitral Valve - physiopathology; Mitral Valve - surgery; Pneumology; Quality of Life; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Systole; Treatment Outcome; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; Ventricular Dysfunction, Left - surgery; left ventricular (ventricle); diastolic stiffness; ESV 125; Tau; HR; LV; EDP; New York Heart Association; end-diastolic pressure; EDV; stiffness constant; time constant of relaxation; coronary artery bypass grafting; NYHA; MR; E A; minimal rate of pressure change; K ED; end-systolic elastance; CABG; 22; dP/dt MAX; PRSW; E ED; end-diastolic pressure–volume relation; end-systolic pressure–volume relation; SVR; cardiac output; dP/dt MIN; effective arterial elastance; stroke work; end-diastolic volume; 30; EDPVR; heart rate; ESP; SV; SW; mitral regurgitation; ESV; end-systolic volume; end-systolic volume intercept at 125 mm Hg; CO; end-systolic pressure; ESPVR; stroke volume; maximal rate of pressure change; E ES; surgical ventricular restoration; preload recruitable stroke work; 17.1; Mitral valve; Cardiovascular disease; Annuloplasty; Coronary heart disease; Long term; Pressure; Treatment; Restoration; Coronary artery bypass; Follow up study; Volume; Anesthesia; Circulatory system; Cardiology; Left ventricle performance
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2010.01.029

Objectives Previous studies demonstrated beneficial short-term effects of surgical ventricular restoration on mechanical dyssynchrony and left ventricular function and improved midterm and long-term clinical parameters. However, long-term effects on systolic and diastolic left ventricular function are still largely unknown. Methods We studied 9 patients with ischemic dilated cardiomyopathy who underwent surgical ventricular restoration with additional restrictive mitral annuloplasty and/or coronary artery bypass grafting. Invasive hemodynamic measurements by conductance catheter (pressure–volume loops) were obtained before and 6 months after surgery. In addition, New York Heart Association classification, quality-of-life score, and 6-minute hall-walk test were assessed. Results At 6 months' follow-up, all patients were alive and clinically in improved condition: New York Heart Association class from 3.3 ± 0.5 to 1.4 ± 0.7, quality-of-life score from 46 ± 22 to 15 ± 15, and 6-minute hall-walk test from 302 ± 123 to 444 ± 78 m (all P  < .01). Hemodynamic data showed improved cardiac output (4.8 ± 1.4 to 5.6 ± 1.1 L/min), stroke work (6.5 ± 1.9 to 7.1 ± 1.4 mm Hg · L; P  = .05), and left ventricular ejection fraction (36% ± 10% to 46% ± 10%; P  < .001). Left ventricular surgical remodeling was sustained at 6 months: end-diastolic volume decreased from 246 ± 70 to 180 ± 48 mL and end-systolic volume from 173 ± 77 to 103 ± 40 mL (both P  < .001). Left ventricular dyssynchrony decreased from 29% ± 6% to 26% ± 3% ( P  < .001) and ineffective internal flow fraction decreased from 58% ± 30% to 42% ± 18% ( P  < .005). Early relaxation (Tau, minimal rate of pressure change) was unchanged, but diastolic stiffness constant increased from 0.012 ± 0.003 to 0.023 ± 0.007 mL−1 ( P  < .001). Conclusions Surgical ventricular restoration with additional restrictive mitral annuloplasty and/or coronary artery bypass grafting leads to sustained left ventricular volume reduction at 6 months' follow-up. We observed improved systolic function and unchanged early diastolic function but impaired passive diastolic properties. Clinical improvement, supported by decreased New York Heart Association class, improved quality-of-life score, and improved 6-minute hall-walk test may be related to improved systolic function, reduced mechanical dyssynchrony, and reduced wall stress.