| Title: | Estimating postoperative left ventricular volume : Identification of responders to surgical ventricular reconstruction |
| Authors: | Wakasa, Satoru Browse this author →KAKEN DB |
| Matsui, Yoshiro Browse this author →KAKEN DB |
| Kobayashi, Junjiro Browse this author |
| Cho, Yasunori Browse this author |
| Yaku, Hitoshi Browse this author |
| Matsumiya, Goro Browse this author |
| Isomura, Tadashi Browse this author |
| Takanashi, Shuichiro Browse this author |
| Usui, Akihiko Browse this author |
| Sakata, Ryuzo Browse this author |
| Komiya, Tatsuhiko Browse this author |
| Sawa, Yoshiki Browse this author |
| Saiki, Yoshikatsu Browse this author |
| Shimizu, Hideyuki Browse this author |
| Yamaguchi, Atsushi Browse this author |
| Hamano, Kimikazu Browse this author |
| Arai, Hirokuni Browse this author |
| Keywords: | surgical ventricular reconstruction |
| ischemic cardiomyopathy |
| coronary artery bypass grafting |
| responder |
| Issue Date: | Dec-2018 |
| Publisher: | Elsevier |
| Journal Title: | Journal of Thoracic and Cardiovascular Surgery |
| Volume: | 156 |
| Issue: | 6 |
| Start Page: | 2088 |
| End Page: | 2096 |
| Publisher DOI: | 10.1016/j.jtcvs.2018.06.090 |
| Abstract: | Objectives: The postoperative left ventricular end-systolic volume index and ejection fraction are benchmarks of surgical ventricular reconstruction but remain unpredictable. This study aimed to identify who could be associated with a higher long-term survival by adding surgical ventricular reconstruction to coronary artery bypass grafting than coronary artery bypass grafting alone (responders to surgical ventricular reconstruction). Methods: The subjects were 293 patients (median age, 63 years; 255 men) who underwent coronary artery bypass grafting for ischemic heart disease with left ventricular dysfunction in 16 cardiovascular centers in Japan. The relationships among surgical ventricular reconstruction, postoperative end-systolic volume index, ejection fraction, and survival were analyzed to identify responders to surgical ventricular reconstruction. Results: Surgical ventricular reconstruction was performed in 165 patients (56%). The end-systolic volume index and ejection fraction significantly improved (end-systolic volume index, 91 to 64 mL/m2; ejection fraction, 28% to 35%) for all patients. The postoperative end-systolic volume index and ejection fraction were estimated, and surgical ventricular reconstruction was found to be significantly associated with both end-systolic volume index (14.5 mL/m2 reduction, P < .001) and ejection fraction (3.1% increase, P = .003). During the median follow-up of 6.8 years, 69 patients (24%) died. Only the postoperative ejection fraction was significantly associated with survival (hazard ratio, 0.925; 95% confidence interval, 0.885-0.968), although this effect was limited to those with postoperative end-systolic volume index of 40 to 80 mL/m2 in the subgroup analysis (hazard ratio, 0.932; 95% confidence interval, 0.894-0.973). Conclusions: Adding surgical ventricular reconstruction to coronary artery bypass grafting could reduce the mortality risk by increasing ejection fraction for those with a postoperative end-systolic volume index within a specific range. The postoperative end-systolic volume index could demarcate responders to surgical ventricular reconstruction, and its estimation can help in surgical decision making. |
| Rights: | © 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| Type: | article (author version) |
| URI: | http://hdl.handle.net/2115/76218 |
| Appears in Collections: | 医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
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