Retrospective evaluation of reverse remodeling of the left ventricle after plastic repair of postinfarction aneurysms in patients

Background. Cardiac remodeling is a complex bidirectional process in which structural and functional parameters of the heart deviate from the norm in response to impaired intracardiac hemodynamics following acute myocardial infarction. Reverse left ventricular (LV) remodeling is manifested by improved systolic and diastolic function due to a decrease in cardiac chamber volume.

Objectives. To analyze the dynamics and degree of reverse remodeling of the left ventricle after surgical correction of post-infarction aneurysms of the left ventricle. Based on the results, develop a model for predicting ultrasound parameters in patients in the postoperative period.

Methods. A retrospective analysis of treatment outcomes was conducted for 174 patients who underwent post-infarction aneurysm repair followed by coronary artery bypass grafting (CABG) at the Nizhny Novgorod Research Institute of Cardiology and the Nizhny Novgorod Clinical Hospital named after Academician B.A. Korolev between 2011 and 2022. Patients were divided into two groups. The first group underwent Cooley repair and CABG, while the second group underwent Dor repair and CABG. The patients had various risk factors that influenced the development of LV remodeling processes. Ultrasound imaging was used to obtain data on the LV and other cardiac structures. Artificial intelligence was used to predict the potential extent of cardiac reconstruction.

Results. A significant reduction in ultrasound measurements of LV volume was observed in patients at various postoperative times. The most significant practical outcome of the study was the development of a clinically applicable machine learning model for predicting surgical outcomes. Its high accuracy (confirmed by a low median error) allows the model to be used for preoperative planning to individualize surgical tactics. The model helps determine the "sweet spot" in the extent of resection — one that is sufficient to initiate reverse remodeling but safe from the risk of low-output syndrome. The implementation of such AI-based decision support systems directly contributes to improved surgical safety and patient outcomes.

Conclusion. In cardiac surgery, a key indicator of success is reverse LV remodeling against the background of heart failure remission after surgery. In recent years, assessment of this process has become a cornerstone of clinical practice, as it serves as the main predictor of a favorable long-term prognosis for patients.

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