Análise dos pacientes submetidos a operação cardíaca para reconstrução ventricular esquerda na Unicamp : estudo retrospectivo / Surgical ventricular restoration at State University of Campinas : a retrospective study

AUTOR(ES)
FONTE

IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia

DATA DE PUBLICAÇÃO

15/09/2011

RESUMO

Introduction: Myocardial infarction might result in dilated left ventricle and numerous techniques were described to restore the original left ventricle shape and identify tools for late survival assessment. The aim of this study is to describe our experience with surgical ventricular restoration (SVR) using modified Dor (MD) procedure using a rigid prosthesis and septal anterior ventricular exclusion (SAVE) procedure and evaluate the EuroSCORE index for late follow up survival. Material and Methods: Between 1999 to 2007, a cohort of 80 patients who underwent left ventricle restoration were evaluated. There were 53 patients who underwent modified Dor procedure with a rigid prosthesis (MD group) and 19 who underwent septal anterior ventricular exclusion procedure (SAVE group). All patients were analyzed for demographic, echocardiograph and catheterization data and were classified according to their left ventricle shape as type I, II or III. Kaplan-Meier and Cox proportional hazard ratio regressions analyses were performed to assess survival after ventricular restoration surgery in both techniques. Expected surgical mortality according to EuroSCORE index was evaluated after 12 years of follow up. Results: Operative mortality was comparable in both groups ranked by EuroSCORE index. Both groups were comparable in the majority of clinical data, however the MD group showed more patient using intra aortic balloon pump before the surgery (5.7% vs. 0.0 %; P <0.01). MD group showed improvement on NYHA functional class and ejection fraction. Kaplan-Meier analyses by left ventricle shape with all patients showed comparable survival, with a slight higher survival with type I. Kaplan-Meier analyses with all mortality showed equivalent survival curves with both techniques after 12 years of follow up (71.5 12.3 vs. 46.6 20.5 years; P = 0.08). Kaplan-Meier analyses by ranked EuroSCORE for all patients showed differences among the three ranked categories, i.e., 0 to 10 %, 11 to 49 % and higher than 50% expected surgical mortality after 12 years of follow up (70.9 16.2 vs. 67.5 12.7 vs. 53.0 15.5; P = 0.003). Conclusions: SVR performed by both techniques showed consistent results with significant improvement in NYHA functional class along follow up period. The MD procedure showed improvement in ejection fraction and left ventricle reshaping after long term follow up. Survival was comparable for all ventricular types and for both techniques applied. EuroSCORE index is a useful index for late survival assessment for surgical ventricular restoration.

ASSUNTO(S)

infarto do miocardio disfunção ventricular aneurisma cardíaco myocardial infarction ventricular dysfunction heart aneurysm

ACESSO AO ARTIGO

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