Boston - American Association for Thoracic Surgery

89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTS3:45 p.m. SIMULTANEOUS SCIENTIFIC SESSION –ADULT CARDIAC SURGERYBallroom A–C, Hynes Convention CenterModerators: Joseph F. SabikDavid H. Adams38. Surgical Ventricular Restoration for Anteroseptal Scars – Volumeor Shape?Antonio M. Calafiore, 1* Angela L. Iacò, 1 Davide Amata, 1 Cataldo Castello, 1Egidio Varone, 1 Fabio Falconieri, 1 Antonio Bivona, 1 Sabina Gallina, 2Michele Di Mauro 31. Cardiac Surgery, University of Catania, Catania, Italy; 2. University of Chieti –Department of Cardiology, Chieti, Italy; 3. University of Catania – Villa BiancaHospital, Catania – Bari, ItalyInvited Discussant: Lorenzo A. MenicantiOBJECTIVE: Surgical ventricular restoration (SVR) has, as a target, reductionof left ventricular (LV) volume. More recently maintaining a conical shape wasconsidered as important as volume reduction. This retrospective analysis comparedthe results of these two strategiesMETHODS: From January 1988 to February 2008, 276 patients with anteroseptalscars underwent elective SVR. Before 2002 a Dor procedure was performed in 107cases (favoring volume reduction, group A). From 2002, 169 patients underwentSVR to maintain a conical LV chamber (favoring shaping, group B); a Dor procedure(when the scar was septoapical) was used in 29 cases and septal reshaping(when the septum was more involved than the anterior wall) in 140. Preoperativelythe 2 groups were similar but age (A 62 ± 10 vs B 66 ± 10 years, p = 0.001), ejectionfraction (EF) (A 38 ± 10 vs B 33 ± 8, p < 0.001), mitral regurgitation grade (A 0.9 ±0.9 vs B 1.7 ± 1.4, p < 0.001) and mitral valve surgery (MVS) rate (A 22.4% vs B46.2%, p < 0.001). Late events included death any cause, NYHA Class III-IV andheart transplantation; cardiac events included cardiac death instead of death any cause.RESULTS: Early mortality was 7.6%, 11.2% (A) versus 5.3% (B) (p = 0.072). Logisticregression, adjusted for age, EF, and MVS showed that the choice of volumereduction (A) more than shape (B) was significantly related to higher early mortality(OR = 5.1, p = 0.002). Four-year freedom from any death was 79.2 ± 2.5 (A 75.7 ±4.1 vs B 81.6 ± 3.2, p = 0.232), from cardiac death was 83.9 ± 2.3 (A 78.3 ± 4.0 vs B87.6 ± 2.8, p = 0.037), from cardiac events was 72.9 ± 2.9 (A 65.8 ± 4.6 vs B 78.3 ± 3.7,p = 0.023) and from any event was 68.8 ± 3.0 (A 63.6 ± 4.7 vs B 72.7 ± 3.8, p = 0.117).Cox analysis, adjusted for age, EF and MVS showed that volume reduction ratherthan LV reshaping provided lower survival (HR = 2.1, p = 0.011), cardiac survival(HR = 3.0, p < 0.001), cardiac event-free survival (HR = 2.7, p < 0.001) and event-freesurvival (HR = 2.2, p < 0.001).CONCLUSION: Maintaining a conical ventricular shape provides better resultswhen compared with pure volume reduction.* AATS Member166