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Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Does preoperative ejection fraction predict operative mortality with left ventricular restoration?
Joshua D Adams1, Lynn M Fedoruk, Carlos A Tache-Leon
1Department of Surgery, University of Virginia, Charlottesville, Virginia 22908, USA. jda2d@virginia.edu
Insights
Left ventricular restoration using the Dor procedure is safe, even with severely reduced ejection fraction (EF). This surgery improves cardiac function, though increased intra-aortic balloon pump (IABP) use may be necessary.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Devices
Background:
- Ischemic cardiomyopathy and aneurysmal disease historically treated with coronary artery bypass grafting.
- The Dor technique offers improved outcomes for ischemic, akinetic ventricles.
- Preoperative low ejection fraction (EF) was hypothesized not to worsen outcomes after ventricular restoration.
Purpose of the Study:
- To evaluate the safety and efficacy of the Dor procedure for left ventricular restoration.
- To compare outcomes in patients with preoperative ejection fraction (EF) < 0.25 versus EF >= 0.25.
- To determine if severely reduced EF is a contraindication for ventricular restoration.
Main Methods:
- Retrospective analysis of patients undergoing Dor procedure (1996-2005).
- Comparison of two groups: preoperative EF < 0.25 and EF >= 0.25.
- Analysis of Society of Thoracic Surgeons database characteristics, mortality, length of stay (LOS), and intra-aortic balloon pump (IABP) use.
Main Results:
- Overall operative mortality was 3.4% with no significant difference between EF groups.
- Length of stay (LOS) and mortality were comparable between groups.
- Increased need for intra-aortic balloon pump (IABP) in the low EF group (39.2% vs 8.1%, p < 0.05).
- Five-year survival was 69.6% for EF < 0.25 and 88.3% for EF >= 0.25 (p = 0.066).
Conclusions:
- Ventricular restoration with the Dor technique is a safe procedure.
- Marked reduction in ejection fraction is not a contraindication for left ventricular restoration.
- Anticipate increased intra-aortic balloon pump usage in patients with severely reduced EF.
Background:
Ischemic cardiomyopathy and aneurysmal disease have been treated surgically with coronary artery bypass grafting in the past. The Dor technique for left ventricular restoration has demonstrated improved outcomes in patients with ischemic, akinetic ventricles. Our hypothesis was that even marked reduction in preoperative cardiac function (ejection fraction < .25) would not correlate with worse outcomes since the ventricle would be reshaped to improve function.
Methods:
A retrospective analysis was performed on all patients who had undergone ventricular restoration with the Dor procedure from January 1996 through September 2005. Patients with a preoperative ejection fraction (EF) < .25 and those with a EF > or = .25 were compared. All Society of Thoracic Surgeons database characteristics, mortality, length of stay (LOS), and need for intraaortic balloon pump (IABP) were analyzed.
Results:
The study included 89 patients (69 men, 20 women), 28 of whom had preoperative EFs < .25 (mean, .183 +/- .035; range, .08 to .25) and 61 had an EF > or = .25 (mean, .334 +/- .074; mean, .25 to .45). Overall operative mortality was 3.4% (3/89), with no statistically significant difference between the two groups (3.6% versus 3.3%). LOS was 7.4 +/- 3.6 days versus 8.9 +/- 15.6 days (p = NS), and need for IABP was 39.2% versus 8.1% (p < 0.05). Overall 5-year survival was 82%. Five-year survival in the EF < .25 cohort was 69.6% versus 88.3% in the EF > or = .25 cohort (p = 0.066).
Conclusions:
Ventricular restoration with the Dor technique is a safe procedure. Marked reduction in ejection fraction is not a contraindication to left ventricular restoration; however, increased usage of IABP should be anticipated.
