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Original Articles: Cardiovascular

Impact of Septal Myocardial Infarction on Outcomes After Surgical Ventricular Restoration

Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland

Accepted for publication April 13, 2007.

^_* Address correspondence to Dr Conte, Division of Cardiac Surgery, Heart and Lung Transplantation, Johns Hopkins Medical Institutions, Blalock 618, 600 North Wolfe St, Baltimore, MD 21287 (Email: jconte{at}csurg.jhmi.jhu.edu).

Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.

Background: Surgical ventricular restoration (SVR) is classically performed in heart failure patients with anteroseptal infarction. It is unknown how the extent of septal myocardial infarction (SMI) affects prognosis. We reviewed our experience to evaluate the impact of the extent of SMI on outcomes after SVR.

Methods: We retrospectively reviewed SVR patients from January 2002 to December 2005. Patients were stratified based on the extent of SMI assessed by magnetic resonance imaging and intraoperative findings; SMI was graded as less than 50%, 50% to 74%, and 75% or greater of the length or height, or both, of the septum. Follow-up was 100%.

Results: Seventy-eight patients underwent SVR. Twenty-eight patients had less than 50%, 30 patients had 50% to 74%, and 20 patients had 75% or greater involvement of the length or height, or both, of the septum. Patients with 75% or greater involvement had a significantly lower ejection fraction and larger left ventricular volumes preoperatively by magnetic resonance imaging. All patients with 75% or greater involvement were New York Heart Association (NYHA) class III/IV preoperatively, and 50% (10 of 20) had significant mitral regurgitation requiring a concomitant mitral valve procedure. Operative mortality was similar between groups. Cardiac function improved and was similar among the three groups postoperatively. The PR intervals on electrocardiography were similar among the three groups, but did show trends toward longer duration for those with more extensive SMI. Preoperative mean QRS duration was significantly longer for patients with 75% or greater SMI. Three-year Kaplan-Meier survival was also similar among groups; 75% or greater involvement was not a predictor of mortality on Cox regression (odds ratio = 1.4; 95% confidence interval: 0.3 to 7.0; p = 0.6). Three quarters (15 of 20) of patients with 75% or greater involvement of the septum improved to NYHA class I/II at follow-up.

Conclusions: This study has evaluated the impact of the extent of SMI on SVR outcomes. These data demonstrate similar survival and significant functional and clinical improvement after SVR regardless of the extent of SMI.