Long-term results of treatment of left ventricular aneurysm of type II–III according to L. Menicanti and ejection fraction of less than 30%
Abstract
In this study we evaluated the long-term results of surgical remodeling of left ventricle (LV) in patients with LV aneurysm of type II and III according to L. Menicanti classification and an ejection fraction <30%.
Material and methods. The retrospective single-center study has included 112 patients with aneurysm of the left ventricle of the second and the third types according to the L. Menicanti classification and an extremely reduced ejection fraction (<30%). Echocardiographic examinations were performed during discharge from the hospital, after 6 months, and then with an outpatient visit of the patient every year after surgery or in case of deterioration of well-being.
Results. In the early postoperative period, 3 patients died as a result of low cardiac output syndrome and developed multiple organ failure syndromes. The evaluation of the results of reconstruction of the left ventricle in the distant period was carried out. The observation period was up to 11 years. In the long term period 12 patients died. Multiple regression analysis was performed to identify risk factors for death. It was found that ventricular arrhythmias, as well as the index of effective stroke volume, are predictors of death in the long-term period in patients after reconstruction of the left ventricle with an ejection fraction <30%. Echocardiographic control has been performed. In all cases the dynamics of reverse remodeling of the left ventricle was revealed, but in patients without mitral valve reconstruction the dynamics of remodeling is more pronounced, and the incidence of MR >II is higher.
Conclusions. 1. In all cases the dynamics of reverse remodeling of the left ventricle was revealed, but in patients without MV reconstruction the dynamics of remodeling is more pronounced, and the incidence of MR >II is higher. 2. Ventricular arrhythmias, as well as the index of effective stroke volume are predictors of long-term death in patients after reconstruction of the left ventricle with an ejection fraction <30%.
Keywords:left ventricular aneurysm, reverse remodeling of left ventricle, low ejection fraction
Conflict of interests. The authors declare no conflict of interests.
For citation: Bazylev V.V., Tungusov D.S., Mikulyak A.I., Senzhapov I.Ya., Bartosh F.L., Nachkebiya B. R. Long-term results of treatment of left ventricular aneurysm of type II–III according to L. Menicanti and ejection fraction of less than 30%. Clin Experiment Surg. Petrovsky J. 2020; 8 (2): 37–44. DOI: 10.33029/2308-1198-2020-8-2-37-44 (in Russian)
Received 13.11.2019. Accepted 26.03.2020.
References
1. Wilkins E., Wilson L., Wickramasinghe K., et al. European Cardiovascular Disease Statistics 2017. Euro- pean Heart Network, Brussels. Available at http://www.ehnheart.org/cvd-statistics.html. Accessed March 9, 2019.
2. Benjamin E.J., Blaha M.J., Chiuve S.E., et al. Heart disease and stroke statistics – 2017 update: a report from the American Heart Association. Circulation. 2017; 135: e146–603.
3. Velagaleti R.S., Pencina M.J., Murabito J.M., et al. Long-term trends in the incidence of heart failure after myocardial infarction. Circulation. 2008; 118: 2057– 62.
4. Bui A.L., Horwich T.B., Fonarow G.C. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011; 8: 30–41.
5. Ponikowski P., Voors A.A., Anker S.D., et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016; 37: 2129– 200.
6. Yancy C.W., Jessup M., Bozkurt B., et al. 2013 ACCF/AHA guideline for the management of heart failure. Circulation. 2013; 128: e240–327.
7. Yancy C.W., Jessup M., Bozkurt B., et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure. J Am Coll Cardiol. 2017; 70: 776–803.
8. Windecker S., Kolh P., Alfonso F., et al. 2014 ESC/ EACTS guidelines on myocardial revascularization. Eur Heart J. 2014; 35: 2541–619.
9. Ibanez B., James S., Agewall S., et al. 2017 ESC guidelines for the management of acute myocardial in- farction in patients presenting with ST-segment elevation. Eur Heart J. 2018; 39 (2): 119–77.
10. Klein P., Braun J., Holman E.R., et al. Management of mitral regurgitation during left ventricular reconstruction for ischemic heart failure. Eur J Cardiothorac Surg. 2012; 41: 74–80.
11. Athanasuleas C.L., Buckberg G.D., Stanley A.W., et al. Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation. J Am Coll Cardiol. 2004; 44: 1439–45.
12. Menicanti L., Castelvecchio S., Ranucci M., et al. Surgical therapy for ischemic heart failure: single-center experience with surgical anterior ventricular restoration. J Thorac Cardiov Sur. 2007; 134: 433–41.
13. Castelvecchio S., Garatti A., Gagliardotto P.V., Menicanti L. Surgical ventricular reconstruction for ischaemic heart failure: State of the art. Eur Heart J Suppl. 2016; 18 (suppl E): E8–14.
14. Dor V., Saab M., Coste P., Kornaszewska M., Montiglio F. Left ventricular aneurysm: a new surgical approach. Thorac Cardiovasc Surg. 1989; 37: 11–9.
15. Thomas J.D. How leaky is that mitral valve? Simplified Doppler methods to measure regurgitant orifice area. Circulation. 1997; 95: 548–50.
16. Lang R.M., Badano L.P., Mor-Avi V., et al. Recommendations for cardiac chamber quantification by echo-cardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imag- ing. 2015; 16: 233–70.
17. Pepi M., Tamborini G., Galli C. et al. A new formula for echo Doppler estimation of right ventricular systolic pressure // J. Am. Soc. Echocardiog. 1994. Vol. 7. P. 20-26.
18. Desta L., Jernberg T., Lofman I., et al. Incidence, temporal trends, and prognostic impact of heart failure complicating acute myocardial infarction. The Swede-heart registry (Swedish web-system for enhancement and development of evidence-based care in heart dis- ease evaluated according to recommended therapies): a study of 199, 851 patients admitted with index acute myocardial infarctions, 1996 to 2008. JACC Heart Fail. 2015; 3: 234–42.
19. Klein P., Holman E.R., Versteegh M.I., et al. Wall motion score index predicts mortality and functional result after surgical ventricular restoration for advanced ischemic heart failure. Eur J Cardiothorac Surg. 2009; 35: 847–52; discussion 852–3.
20. Levine R.A., Hung J., Otsuji Y., et al. Mechanistic insights into functional mitral regurgitation. Curr Cardiol Rep. 2002; 4: 125–9.
21. Rosseykin E.V., Kobzev E.E., Popylkova O.V., Durmanov S.S., Bazylev V.V. Risk factors for life-threatening ventricular arrhythmias after surgical reconstruction of the left ventricle. Angiologiya i sosudistaya khirurgiya [Angiology and Vascular Surgery]. 2018; 24 (2): 158–63. (in Russian)