Estimating postoperative left ventricular volume: Identification of responders to surgical ventricular reconstruction

Satoru Wakasa, Yoshiro Matsui, Junjiro Kobayashi, Yasunori Cho, Hitoshi Yaku, Goro Matsumiya, Tadashi Isomura, Shuichiro Takanashi, Akihiko Usui, Ryuzo Sakata, Tatsuhiko Komiya, Yoshiki Sawa, Yoshikatsu Saiki, Hideyuki Shimizu, Atsushi Yamaguchi, Kimikazu Hamano, Hirokuni Arai

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Fingerprint

Coronary Artery Bypass
Survival
Confidence Intervals
Benchmarking
Left Ventricular Dysfunction
Stroke Volume
Myocardial Ischemia
Decision Making
Japan
Mortality

Keywords

  • coronary artery bypass grafting
  • ischemic cardiomyopathy
  • responder
  • surgical ventricular reconstruction

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Estimating postoperative left ventricular volume : Identification of responders to surgical ventricular reconstruction. / Wakasa, Satoru; Matsui, Yoshiro; Kobayashi, Junjiro; Cho, Yasunori; Yaku, Hitoshi; Matsumiya, Goro; Isomura, Tadashi; Takanashi, Shuichiro; Usui, Akihiko; Sakata, Ryuzo; Komiya, Tatsuhiko; Sawa, Yoshiki; Saiki, Yoshikatsu; Shimizu, Hideyuki; Yamaguchi, Atsushi; Hamano, Kimikazu; Arai, Hirokuni.

In: Journal of Thoracic and Cardiovascular Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Wakasa, S, Matsui, Y, Kobayashi, J, Cho, Y, Yaku, H, Matsumiya, G, Isomura, T, Takanashi, S, Usui, A, Sakata, R, Komiya, T, Sawa, Y, Saiki, Y, Shimizu, H, Yamaguchi, A, Hamano, K & Arai, H 2018, 'Estimating postoperative left ventricular volume: Identification of responders to surgical ventricular reconstruction', Journal of Thoracic and Cardiovascular Surgery. https://doi.org/10.1016/j.jtcvs.2018.06.090
Wakasa, Satoru ; Matsui, Yoshiro ; Kobayashi, Junjiro ; Cho, Yasunori ; Yaku, Hitoshi ; Matsumiya, Goro ; Isomura, Tadashi ; Takanashi, Shuichiro ; Usui, Akihiko ; Sakata, Ryuzo ; Komiya, Tatsuhiko ; Sawa, Yoshiki ; Saiki, Yoshikatsu ; Shimizu, Hideyuki ; Yamaguchi, Atsushi ; Hamano, Kimikazu ; Arai, Hirokuni. / Estimating postoperative left ventricular volume : Identification of responders to surgical ventricular reconstruction. In: Journal of Thoracic and Cardiovascular Surgery. 2018.
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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.",
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author = "Satoru Wakasa and Yoshiro Matsui and Junjiro Kobayashi and Yasunori Cho and Hitoshi Yaku and Goro Matsumiya and Tadashi Isomura and Shuichiro Takanashi and Akihiko Usui and Ryuzo Sakata and Tatsuhiko Komiya and Yoshiki Sawa and Yoshikatsu Saiki and Hideyuki Shimizu and Atsushi Yamaguchi and Kimikazu Hamano and Hirokuni Arai",
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T2 - Identification of responders to surgical ventricular reconstruction

AU - Wakasa, Satoru

AU - Matsui, Yoshiro

AU - Kobayashi, Junjiro

AU - Cho, Yasunori

AU - Yaku, Hitoshi

AU - Matsumiya, Goro

AU - Isomura, Tadashi

AU - Takanashi, Shuichiro

AU - Usui, Akihiko

AU - Sakata, Ryuzo

AU - Komiya, Tatsuhiko

AU - Sawa, Yoshiki

AU - Saiki, Yoshikatsu

AU - Shimizu, Hideyuki

AU - Yamaguchi, Atsushi

AU - Hamano, Kimikazu

AU - Arai, Hirokuni

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - coronary artery bypass grafting

KW - ischemic cardiomyopathy

KW - responder

KW - surgical ventricular reconstruction

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