A single center’s experience with total arterial revascularization and spiral aneurysmorrhaphy for ischemic cardiac disease
- 24 Downloads
The restoration of left ventricular (LV) geometry in combination with coronary artery bypass grafting for the treatment of ischemic cardiac disease remains controversial. We hereby present the experience of our center with total arterial myocardial revascularization (TAMR) and spiral aneurysmorrhaphy for ischemic heart disease. A retrospective analysis of 101 patients with advanced cardiovascular disease who underwent TAMR and spiral aneurysmorrhaphy was performed. Spiral aneurysmorrhaphy is a modification of the linear aneurysmorrhaphy and was applied to patients who had a LV aneurysm with a diameter of less than 5 cm. Peri-operative and in-hospital data were retrieved. The majority of the patients were male (87.13%) with a mean age of 63.1 years. Mean pre-operative ejection fraction (EF) was 35.7% ranging between 20 and 65%. An average of 3.23 grafts was required per patient. Early mortality was 6.93% (one intra-operative and six in-hospital deaths). Addition of concomitant valve surgery was associated with prolonged total operative, cardiopulmonary bypass and cross-clamp time (p < 0.001), increased need for blood (p = 0.012) and plasma (p = 0.038), longer intensive care unit (ICU) stay (p = 0.045) and higher rate of post-operative cerebrovascular accident (p = 0.011). Furthermore, patients with a pre-operative EF between 30 and 50% had a shorter ICU stay (p = 0.045) and LoS (p = 0.029) compared with patients with EF <30%. Early mortality and post-operative complication rates following this combined procedure are in consistency with the relevant available data suggesting its feasibility regardless of the EF or addition of concomitant surgeries. Data from the follow-up of these patients are required to examine the long-term efficacy of this surgical modality.
KeywordsTotal arterial revascularization Aneurysmorrhaphy Ischemic heart disease Left ventricular aneurysm
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
- 2.Athanasuleas CL, Buckberg GD, Stanley AWH, Silver W, Dor V, Di Donato M, Menicanti L, Almeida de Oliveira S, Beyersdorf F, Kron IL, Suma H, Kouchoukos NT, Moore W, McCarthy PM, Oz MC, Fontan F, Scott ML, Accola KA; RESTORE Group (2004) Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation. J Am Coll Cardiol 44:1439–1445CrossRefPubMedGoogle Scholar
- 8.Parolari A, Naliato M, Loardi C, Denti P, Trezzi M, Zanobini M, Porgueddu M, Roberto M, Kassem S, Alamanni F, Tremoli E, Biglioli P (2007) Surgery of left ventricular aneurysm: a meta-analysis of early outcomes following different reconstruction techniques. Ann Thorac Surg 83:2009–2016CrossRefPubMedGoogle Scholar
- 9.Jones RH, Velazquez EJ, Michler RE, Sopko G, Oh JK, O'Connor CM, Hill JA, Menicanti L, Sadowski J, Desvigne-Nickens P, Rouleau JL, Lee KL, STICH Hypothesis 2 Investigators (2009) Coronary bypass surgery with or without surgical ventricular reconstruction. N Engl J Med 360:1705–1717CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Wakasa S, Matsui Y, Isomura T, Takanashi S, Yamaguchi A, Komiya T, Cho Y, Kobayashi J, Yaku H, Kohaji K, Arai H, Sawa Y (2014) Risk scores for predicting mortality after surgical ventricular reconstruction for ischemic cardiomyopathy: results of a Japanese multicenter study. J Thorac Cardiovasc Surg 147:1868–1874CrossRefPubMedGoogle Scholar
- 15.Executive Summary STS Adult Cardiac Surgery Database. https://www.sts.org/sites/default/files/documents/ACSD_2017Harvest2_ExecutiveSummary.pdf. Accessed 13 Nov 2018
- 17.Buckberg GD (2004) Ventricular restoration–a surgical approach to reverse ventricular remodeling. Heart Fail Rev 9:233–239; discussion 347–351Google Scholar
- 21.Yamazaki S, Doi K, Numata S, Itatani K, Kawajiri H, Morimoto K, Manabe K, Ikemoto K, Yaku H (2016) Ventricular volume and myocardial viability, evaluated using cardiac magnetic resonance imaging, affect long-term results after surgical ventricular reconstruction. Eur J Cardiothorac Surg 50:704–712CrossRefPubMedGoogle Scholar
- 22.Temizturk Z, Azboy D, Atalay A, Atalay H, Dogan OF (2016) the effects of levosimendan and sodium nitroprusside combination on left ventricular functions after surgical ventricular reconstruction in coronary artery bypass grafting patients. Open Cardiovasc Med J 10:138–147CrossRefPubMedPubMedCentralGoogle Scholar