Risk factors for mortality and hospital re-admission after surgical ventricular restoration.

BACKGROUND: Surgical ventricular restoration is an option in patients with coronary artery disease, heart failure, postinfarction left ventricular aneurysm or ischemic dilated cardiomyopathy with or without ventricular tachycardia. The aims of this study were to investigate survival and re-admission for heart failure and to identify predictors for early and long-term mortality and re-admission after surgical ventricular restoration.

METHODS: Pre- and postoperative data were collected for 136 consecutive patients who underwent surgical ventricular restoration for postinfarction left ventricular aneurysm or ischemic dilated cardiomyopathy during 1994-2005. Survival and risk factors for mortality and hospital re-admission were analyzed by using multivariable models.

RESULTS: Early mortality was 10/136 (7.4%). At 1, 3, 5 and 9 years overall actuarial survival was 89%, 80%, 68% and 62%. Increasing age, diabetes and mitral regurgitation grade III-IV were associated with an increased risk for late mortality. Freedom from re-hospitalization due to heart failure or cardiac death in operative survivors at 1, 3 and 5 years was 78%, 72% and 58%. Risk factors for re-hospitalization or cardiac death in operative survivors were increasing age and increasing grade of mitral regurgitation.

CONCLUSIONS: Surgical ventricular restoration by the Dor procedure can achieve good long-term survival and a high degree of freedom from readmission for heart failure in patients with advanced ischemic heart disease. We found a strong association between increasing grade of mitral regurgitation and both long-term mortality and re-admission for heart failure.