The effect of surgical ventricular restoration technics on left ventricular remodeling in different heart failure phenotypes
Authors: Bursacovschi D , Cazacu J , Lisii D , Vataman E 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Cardiac remodeling represents a major cause of heart failure (HF) as well as cardiac morbidity and mortality [1], surgical ventricular restoration (SVR) improve left ventricular function, clinical condition and heart failure [2].

Objectives
We assessed the early outcomes after open-heart surgery, which included techniques of ventricular restorations on left ventricular dimensions and function. Additionally we evaluated the effect of SVR according to the heart failure phenotypes.

Material and Methods
A 4 months prospective observational study enrolled 100 patients that underwent procedures of surgical ventricular restoration through Dor and Jatene method. All patients were evaluated through chest echocardiography at presentation, before surgery and at the end of heart rehabilitation program. In addition, we analyzed the left ventricle indices according to three heart failure phenotypes: group 1 (Gr.1) – HF with preserved EF, group 2 (Gr. 2) – HF with mildly reduced EF, group 3 (Gr. 3) – HF with reduced EF.

Results
The left ventricle diameter and volume in systole and diastole registered statistically significant differences (p &lt;0.001) both in the general group and in the different clinical phenotypes of HF.
The end-systolic diameter of the left ventricle decreased significantly in the general group compared to the rehabilitation stage and the preoperative by – 2, 0 ± 0, 6.
Regarding the end-systolic volume of the left ventricle, the statistical significant differences (p&lt;0.001, Fig.1) were marked at the stage of cardiac rehabilitation compared to the preoperative stage both in the general group with -13.0 ± 4.6. The same comparative analysis showed the relation between the groups Gr. 1: -1.2 ± 3.4, Gr. 2: -6.9 ± 8.5, Gr. 3: -42.5 ± 11.8.
The systolic function of the left ventricle expressed through the EF (Fig.2) also meets a growth / improvement dynamics (p &lt;0.001) assessed by comparative analysis of data at the stage of cardiac rehabilitation compared to the preoperative stage. It was found for the general group an increase of 1.0 ± 0.7, and a more obvious increase for Gr. 2: 3.6 ± 1.5 and Gr. 3: 4.2 ± 1.4.

Conclusion
The dynamics of left ventricular remodeling parameters in patients undergoing surgery shows statistically significant growth both in the general group and in the sub-group analysis. It induces significant decrease in the end-systolic and end-diastolic diameters and volumes of the left ventricle at the post-rehabilitation stage in all three groups. Therefore, surgical ventricular restorations influence the further positive outcomes on left ventricular function. The contraction function of the left ventricular myocardium registered a slightly positive dynamics, fact highlighted by the comparative analysis of the post-rehabilitation phase with the preoperative one, the increase of the EF being subtle in the general group and more expressed for the group with the slightly reduced ejection and with low ejection fraction.