Preoperative Parameters Predicting the Postoperative Course of Endoventricular Circular Patch Plasty

Keiichiro Kondo, MD, Yoshihide Sawada, MD, and Shinjiro Sasaki, MD, PhD

It is necessary that preoperative factors predicting the postoperative course be easily and precisely documented. We investigated the preoperative predictors and defined the indications of endoventricular circular patch plasty (EVCPP) in patients with ischemic cardiomyopathy (ICM). Between October 1997 and May 2001, 22 patients (19 males and 3 females; mean age 63.4 years, range 50 to 75 years) with ICM underwent EVCPP. Only one patient underwent EVCPP alone. Coronary artery bypass grafting (CABG) associated with EVCPP was performed in 18 patients (82%). Twenty-two patients were divided into two groups according to the outcome after surgery. Group A consists of three patients who died after surgery and two who showed no clinical improvement after surgery. Group B comprises 17 patients who showed clinical improvement in terms of New York Heart Association (NYHA) functional class, freedom from angina or congestive heart failure. The left ventricular systolic dimensions (LVDs) in group A was significantly longer compared with that in group B (p=0.02, 5.8 versus 4.8 cm). They were not statistically different in other variables between the two groups. We analyzed 10 preoperative variables which are categorized as crucial predictors of postoperative course. We found statistically significant differences in LVDs greater than or equal to 5.5 cm and fractional shortening (FS) less than or equal to 15% (p=0.0393, p=0.0207) as well as an increased odds ratio (13, 18.6667, respectively) between A and B groups. In the present study, LVDs and FS demonstrated the dimensional alteration of the cardiac basal segment, and identify the degree of contraction in the nonaneurysmal portion of the ventricle which will remain after surgery. Therefore, LVDs and FS indicating the functional reserve of the basal segment of the ventricle after EVCPP may be the most important parameters predicting the postoperative course. (Ann Thorac Cardiovasc Surg 2002; 8: 363-363)

Key words: ischemic cardiomyopathy, endoventricular circular patch plasty, volume reduction surgery, echocardiography

From Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, Japan

Received June 27, 2002; accepted for publication August 16, 2002
Address reprint requests to Keiichiro Kondo, MD: Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki-city, Osaka 569-8686, Japan.