Contemporary performance of surgical ventricular restoration procedures: data from the Society of Thoracic Surgeons' National Cardiac Database.

BACKGROUND: Surgical ventricular restoration (SVR) is an operation that demonstrates promise to improve outcomes for patients with left ventricular dysfunction. Current use and operative outcomes of SVR have come from centers of expertise, and operative risks of SVR in community practice are unknown. We sought to characterize the performance of SVR nationally and describe the acute risks of mortality and major morbidity plus predictors of adverse outcomes. METHODS: We identified patients undergoing an SVR procedure at US hospitals participating in the Society of Thoracic Surgeons (STS) National Cardiac Database from January 2002 to June 2004. Baseline characteristics, operative characteristics, clinical outcomes, and predictors of adverse procedural outcomes were analyzed. RESULTS: There were 731 patients who underwent SVR at 141 of STS's 576 hospitals, and 20 centers performed 10 SVR procedures or more. The operative mortality was 9.3%; reoperation in 14.1%, stroke in 3.3%, renal failure in 8.1%, and prolonged ventilation in 21.5%. Combined death or major complications occurred in 33.5%. Major predictors of this combined end point were age, female sex, creatinine > or = 2 mg/dL, insulin-dependent diabetes, myocardial infarction within 1 week, history of congestive heart failure, 3-vessel coronary disease, severe mitral insufficiency, and status of surgery. CONCLUSION: This study provides a first look at use and outcomes of SVR in a national sample. Although a quarter of STS sites are performing SVR, most have limited experience and perioperative events are somewhat higher than prior selected series. Further studies of SVR are needed to improve patient selection and procedural performance.

Duke Scholars

Author Adrian Felipe Hernandez Medicine, Cardiology

Author Sean Michael O'Brien Biostatistics & Bioinformatics, Division of Biostatistics