Impact of surgical ventricular reconstruction on stroke volume in patients with ischemic cardiomyopathy

DM Di, F Fantini, A Toso, S Castelvecchio, L Menicanti, L Annest and D Burkhoff
J Thorac.Cardiovasc.Surg. 2010;140:1325-1331

OBJECTIVE: Left ventricular end-diastolic volume is decreased and ejection fraction is increased after surgical ventricular reconstruction; however, the impact on left ventricular stroke volume is not well established. METHODS: We analyzed 248 consecutive patients who underwent surgical ventricular reconstruction at a single center. There were 14 perioperative deaths (5.6%). The 234 surviving patients had pre- and postsurgical ventricular reconstruction echocardiographic measurement of end-diastolic volume, end-systolic volume, and stroke volume, each indexed to body size and ejection fraction. A total of 120 patients had echocardiography data at follow-up (median 8 months). RESULTS: Overall, surgical ventricular reconstruction resulted in reductions in end-diastolic volume index (-30% +/- 18%) and end-systolic volume index (-37% +/- 20%), and increases in ejection fraction (21% +/- 18% relative increase). However, stroke volume index decreased from 35 +/- 8 mL/m(2) preoperatively to 28 +/- 7 mL/m(2) early postoperatively (a 17% +/- 24% relative reduction, P < .0001); 165 patients (71%) exhibited a decrease and 69 patients (29%) exhibited an increase or no change in stroke volume index after surgical ventricular reconstruction. Stroke volume index reduction was strictly related to end-diastolic volume reduction. Patients who initially had a stroke volume index decrease showed recovery, so that at the time of chronic follow-up there was no significant difference between the groups. Notably, 4-year survival was approximately 85% and did not differ between patients with an increase or decrease in stroke volume index (P = .383). CONCLUSIONS: Although surgical ventricular reconstruction uniformly results in an impressive decrease in end-diastolic volume index and increase in ejection fraction, seemingly indicating beneficial remodeling and improved pump function, systolic volume index, which more directly indexes cardiac pump function, frequently decreases after surgical ventricular reconstruction. Further study is needed to identify baseline characteristics that predict those patients in whom cardiac performance is enhanced by surgical ventricular reconstruction and to clarify whether there is a beneficial impact on exercise tolerance and cardiac output at peak exercise.

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