Left ventricular surgical restoration for anteroseptal scars: volume versus shape

Objective: We report the long-term results of left ventricular surgical restoration in which 2 different strategies
were used, which had restoration of ventricular volume or ventricular shape as their target.
Methods: From 1988 to 2008, 308 patients with anterior scars underwent elective left ventricular surgical
restoration. Before 2002, a Dor procedure was performed in 107 cases to reduce left ventricular volume (group
V); from 1998 to 2001, a Guilmet procedure was performed in 32 patients to rebuild a left ventricular conical
shape (group S). From 2002, 169 patients (group S) underwent left ventricular surgical restoration to reshape a conical
left ventricle by means of the Dor procedure (n ¼ 29, septoapical scars) or septal reshaping (n ¼ 140, when the
septum was more involved than the anterior wall). The 2 groups were similar for all features but age, mitral
regurgitation grade, mitral valve surgery rate (higher in group S), and ejection fraction (higher in group V).
Results: Early mortality was 7.8% (11.2% in group V vs 6.0% in group S, P ¼ .102). Logistic regression
showed that volume reduction was significantly related to higher early mortality. Five-year cardiac survival,
cardiac event–free survival, and event-free survival were higher in group S. Cox analysis showed that the choice
of volume reduction provided lower survival (hazard ratio, 2.1), cardiac survival (hazard ratio, 3.0), cardiac
event–free survival (hazard ratio, 2.7), and event-free survival (hazard ratio, 2.2). When 30-day events were
excluded, volume reduction was still a risk factor for cardiac event–free survival (hazard ratio, 2.2).
Conclusions: When the main target of left ventricular surgical restoration is left ventricular reshaping rather
than left ventricular volume reduction, early and late outcomes seem to improve.