Title of article :
Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation Original Research Article
Author/Authors :
Constantine L. Athanasuleas، نويسنده , , Gerald D. Buckberg، نويسنده , , Alfred W.H. Stanley، نويسنده , , William Siler، نويسنده , , Vincent Dor، نويسنده , , Marisa Di Donato، نويسنده , , Lorenzo Menicanti، نويسنده , , Sergio Almeida de Oliveira، نويسنده , , Friedhelm Beyersdorf، نويسنده , , Irving L. Kron، نويسنده , , Hisayoshi Suma، نويسنده , , Nicholas T. Kouchoukos، نويسنده , , Wistar Moore، نويسنده , , Patrick M. McCarthy، نويسنده , , Mehmet C. Oz، نويسنده , , Francis Fontan، نويسنده , , Meredith L. Scott، نويسنده , , Kevin A. Accola and RESTORE Group، نويسنده ,
Issue Information :
روزنامه با شماره پیاپی سال 2004
Pages :
7
From page :
1439
To page :
1445
Abstract :
Objectives The purpose of this study was to test how surgical ventricular restoration (SVR) affects early and late survival in a registry of 1,198 post-anterior infarction congestive heart failure (CHF) patients treated by the international Reconstructive Endoventricular Surgery returning Torsion Original Radius Elliptical shape to the left ventricle (RESTORE)team. Background Congestive heart failure may be caused by late left ventricular (LV) dilation after anterior infarction. The infarcted segment is often akinetic rather than dyskinetic because early reperfusion prevents transmural necrosis. Previously, only dyskinetic areas were treated by operation. Surgical ventricular restoration reduces LV volume and creates a more elliptical chamber by excluding scar in either akinetic or dyskinetic segments. Methods The RESTORE group applied SVR to 1,198 post-infarction patients between 1998 and 2003. Early and late outcomes were examined, and risk factors were identified. Results Concomitant procedures included coronary artery bypass grafting in 95%, mitral valve repair in 22%, and mitral valve replacement in 1%. Overall 30-day mortality after SVR was 5.3% (8.7% with mitral repair vs. 4.0% without repair; p < 0.001). Perioperative mechanical support was uncommon (<9%). Global systolic function improved postoperatively. Ejection fraction (EF) increased from 29.6 ± 11.0% preoperatively to 39.5 ± 12.3% postoperatively (p < 0.001). The left ventricular end-systolic volume index (LVESVI) decreased from 80.4 ± 51.4 ml/m2 preoperatively to 56.6 ± 34.3 ml/m2 postoperatively (p < 0.001). Overall five-year survival was 68.6 ± 2.8%. Logistic regression analysis identified EF ≤30%, LVESVI ≥80 ml/m2, advanced New York Heart Association (NYHA) functional class, and age ≥75 years as risk factors for death. Five-year freedom from hospital readmission for CHF was 78%. Preoperatively, 67% of patients were NYHA functional class III or IV and postoperatively, 85% were class I or II. Conclusions Surgical ventricular restoration improves ventricular function and is highly effective therapy in the treatment of ischemic cardiomyopathy with excellent five-year outcome.
Keywords :
ACE , ejection fraction , Left ventricular , angiotensin-converting enzyme , Congestive heart failure , CABG , CHF , LV , NYHA , New York Heart Association , EF , coronary artery bypass grafting , LVAD , left ventricular assist device , SVR , surgical ventricular restoration , LVESVI , left ventricular end-systolic volume index
Journal title :
JACC (Journal of the American College of Cardiology)
Serial Year :
2004
Journal title :
JACC (Journal of the American College of Cardiology)
Record number :
459467
Link To Document :
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