Why the study?
Surgical ventricular restoration improves function via volume reduction and geometry restoration, but refining procedure planning using cardiac computed tomography was needed.
Does cardiac computed tomography (CCT) accurately predict postoperative left ventricular volume and help estimate survival in patients undergoing surgical ventricular restoration?
Does cardiac computed tomography (CCT) accurately predict postoperative left ventricular volume and help estimate survival in patients undergoing surgical ventricular restoration?
Cardiac computed tomography accurately predicts postoperative left ventricular volume and helps estimate survival in patients undergoing surgical ventricular restoration.
CCT planning may refine SVR volume targets; leaves open whether it improves outcomes versus standard methods in randomized trials.
Background Surgical ventricular restoration (SVR) leads to functional improvement by volume reduction and restoration of left ventricular (LV) geometry. Our purpose was to refine the planning for SVR using cardiac computed tomography (CCT). Methods The possibility to anticipate the postoperative residual LV volume was assessed using CCT in 205 patients undergoing SVR combined with coronary artery bypass grafting (77%), mitral valve repair/replacement (19%) and LV thrombectomy (19%). The potential of CCT to guide the procedure was evaluated. Additionally, the predictive value of CCT characteristics on survival was addressed. Results 30-day, 1- and 5-year survival was 92.6, 82.7, and 72.1%, respectively, with a marked reduction of NYHA class III-IV quota after surgery (95.1% vs. 20.5% in the follow-up). Both pre- and postoperative LV end-systolic volume index (LVESVI) were predictive of all defined endpoints according to the following tertiles: preoperative: <74 ml/m 2 , 74–114 ml/m 2 and >114 ml/m 2 ; postoperative: <58 ml/m 2 , 58–82 ml/m 2 and >82 ml/m 2 . On average, a 50 ml/m 2 increase of preoperative LVESVI was associated with a 35% higher hazard of death ( p = 0.043). Aneurysms limited to seven antero-apical segments ( 1 – 7 ) were associated with a lower death risk ( n = 60, HR 0.52, CI 0.28–0.96, p = 0.038). LVESVI predicted by CCT was found to correlate significantly with effectively achieved LVESVI ( r = 0.87 and r = 0.88, respectively, p < 0.0001). Conclusions CCT-guided SVR can be performed with good mid-term survival and significant improvement in HF severity. CCT-based assessment of achievable postoperative LV volume helps estimate the probability of therapeutic success in individual patients.
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Solowjowa et al. (2022) studied this question.
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