Intermediate survival and predictors of death after surgical ventricular restoration

Area of Science:

• Cardiology
• Cardiac Surgery

Background:

• Patients with transmural anterior myocardial infarction often develop left ventricular dysfunction, leading to heart failure, angina, or arrhythmias.
• Surgical left ventricular reconstruction aims to improve cardiac function and patient survival.

Purpose of the Study:

• To evaluate the long-term survival impact of the Dor procedure (endoventricular patch-plasty repair) for left ventricular reconstruction.
• To identify preoperative, perioperative, and postoperative predictors of late survival after this procedure.

Main Methods:

• Retrospective analysis of 207 patients undergoing left ventricular reconstruction via endoventricular patch-plasty.
• Univariate analysis of clinical, hemodynamic, and functional variables, alongside operative parameters.
• Cox regression analysis to determine independent predictors of mortality.

Main Results:

• The study group of 207 patients experienced a mean follow-up of 39 months, with 30 adverse events (27 deaths, 3 heart transplants).
• Event-free survival rates were 98% at 1 year, 95.8% at 2 years, and 82.1% at 5 years.
• Preoperative New York Heart Association functional class, ejection fraction, end-systolic volume index, and remote asynergy were independent predictors of mortality.

Conclusions:

• The Dor procedure demonstrates a favorable impact on 5-year survival for patients with previous myocardial infarction and left ventricular dysfunction.
• Preoperative functional status and left ventricular systolic function are crucial independent predictors of long-term survival.