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Ann Thorac Surg 2010;89:1524-1531. doi:10.1016/j.athoracsur.2010.01.067
© 2010 The Society of Thoracic Surgeons
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Takeshi Nishina
Takeshi Shimamoto
Tadashi Ikeda
Ryuzo Sakata
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Original Articles: Adult Cardiac

Significance of Left Ventricular Diastolic Function on Outcomes After Surgical Ventricular Restoration

Akira Marui, MD, PhD*, Takeshi Nishina, MD, PhD, Yoshiaki Saji, MD, Kazuhiro Yamazaki, MD, PhD, Takeshi Shimamoto, MD, Tadashi Ikeda, MD, PhD, Ryuzo Sakata, MD, PhD

Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan

Accepted for publication January 28, 2010.

* Address correspondence to Dr Marui, Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara, Sakyo, Kyoto, 606-8507 Japan (Email: marui{at}kuhp.kyoto-u.ac.jp).

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: Surgical ventricular restoration (SVR) has been introduced to restore the dilated left ventricular (LV) chamber and improve LV systolic function; however, SVR has also been reported to detrimentally affect LV diastolic properties. We sought to investigate the impact of preoperative LV diastolic function on outcomes after SVR in patients with heart failure.

Methods: Sixty-seven patients (60 ± 14 years) with LV systolic dysfunction (LV ejection fraction, 0.27 ± 0.10) underwent SVR. They were evaluated by echocardiography preoperatively, and early (≤1 month) and late (mean, 3.4 years) after surgery. Patients were divided into three groups according to the preoperative diastolic filling patterns of transmitral flow (impaired relaxation, pseudonormal, and restrictive filling patterns).

Results: Patients in the restrictive group showed far greater cardiovascular mortality than the other two groups (p < 0.0001). The multivariate analysis showed that preoperative restrictive filling pattern was a predominant predictor for adjusted cardiovascular death (p = 0.023; hazard ratio = 3.0). Left ventricular ejection fraction, LV end-diastolic volume, and grade of mitral regurgitation improved in all groups early after surgery; however, these variables in the restrictive group significantly deteriorated late after surgery (from 29 ± 8 to 25 ± 6 for LV ejection fraction; from 183 ± 59 to 226 ± 53 for left ventricular end-diastolic volume; and from 0.7 ± 0.6 to 1.7 ± 0.9 for mitral regurgitation grade; p < 0.05 for all).

Conclusions: In patients with LV systolic dysfunction undergoing SVR, preoperative restrictive LV diastolic filling pattern strongly related to higher mortality with aggravation of LV systolic function, mitral regurgitation grade, or LV remodeling. This might be attributable to deterioration of diastolic function induced by SVR.






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