Ann Thorac Surg 2009;87:461-462. doi:10.1016/j.athoracsur.2008.10.080
© 2009 The Society of Thoracic Surgeons
Original Articles: Adult Cardiac
Invited Commentary
Anders Franco-Cereceda, MD, PhD
Department of Thoracic Surgery, Karolinska University Hospital, Stockholm, 171 76 Sweden
(Email: andfra{at}mbox.ki.se).
Heart failure progression is characterized by left ventricular remodeling, including dilatation and thinning of the ventricular wall combined with worsening of cardiac function. Left ventricular dilatation is a strong predictor of poor outcome in heart failure patients, and various surgical options have therefore been developed to prevent or reverse the remodeling process through ventricular reconstruction surgery. A wide spectrum of left ventricular shape abnormalities develop in patients with ischemic dilated cardiomyopathy, ranging from true aneurysm to global dilatation. All are amendable to ventricular restoration surgery.
In this retrospective study [1], the outcome of a very large cohort of patients who underwent ventricular restoration procedures has been reviewed according to the extent of postinfarction left ventricular shape abnormalities, divided into "true aneurysm," "intermediate" and "dilated cardiomyopathy." Although coronary artery bypass grafting and mitral valve procedures were performed when needed, the common denominator for all patients was ventricular restoration surgery. The authors clearly demonstrate that all types of ventricular shape differences can be operated on with remodeling surgery, with similarly good results.
However, the importance of this article does not lie in the surgical results but rather the attempt to define the various types of shape differences in postinfarction ventricular remodeling and relate this to surgical outcome. They thereby invite all others working with these patients to do the same. This will be of tremendous benefit when trying to define, compare, and evaluate patient selection, surgical options, and postoperative results in this otherwise very heterogenous group of patients. This is indeed an important contribution and the authors are to be commended for that!
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References
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- Di Donato M, Castelvecchio S, Kukulski T, et al. Surgical ventricular restoration: left ventricular shape influence on cardiac function, clinical status, and survival Ann Thorac Surg 2009;87:455-462.[Abstract/Free Full Text]
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