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Fatehi Hassanabad A, Wiebe K, Ali IS. Clinical and hemodynamic outcomes of the Dor procedure in adults with ischemic cardiomyopathy. J Card Surg 2021; 36:4345-4366. [PMID: 34494297 DOI: 10.1111/jocs.15968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/07/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022]
Abstract
Ischemic cardiomyopathy continues to be a major contributor to congestive heart failure, which places a significant burden on our healthcare system. Improving medications and different coronary revascularization strategies are the mainstays in the management of ischemic cardiomyopathy. Although medications and mechanical circulatory support are playing an ever-increasing role, cardiac transplantation remains the gold standard for treating advanced heart failure. Given the small number of available and suitable donor hearts, transplantation is limited for the majority of patients. Surgical ventricular restoration has repeatedly been suggested as a viable alternative in managing heart failure in select patients, as it is believed that surgically returning the ventricle to its original dimensions is possible and associated with favorable outcomes. The purpose of this manuscript is to comprehensively review the current literature on various surgical strategies for ventricular restoration. We also contextualize the published data with respect to ventricular function, volume, structure, arrhythmias, mitral regurgitation, and clinical outcomes.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kiana Wiebe
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Imtiaz S Ali
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Contreras CAM, Orellana PX, Almeida AFSD, Finger MA, Rossi JM, Chaccur P. Left Ventricular Reconstruction Surgery in Candidates for Heart Transplantation. Braz J Cardiovasc Surg 2019; 34:265-270. [PMID: 31310463 PMCID: PMC6629223 DOI: 10.21470/1678-9741-2018-0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective To report our center’s experience in the surgical treatment of ventricular
reconstruction, an effective and efficient technique that allows patients
with end-stage heart failure of ischemic etiology to have clinical
improvement and increased survival. Methods Observational, clinical-surgical, sequential, retrospective study. Patients
with ischemic cardiomyopathy and left ventricular aneurysm were attended at
the Heart Failure, Ventricular Dysfunction and Cardiac Transplant outpatient
clinic of the Dante Pazzanese Cardiology Institute, from January 2010 to
December 2016. Data from 34 patients were collected, including systemic
arterial hypertension, ejection fraction, New York Heart Association (NYHA)
functional classification (FC), European System for Cardiac Operative Risk
Evaluation (EuroSCORE) II value, Society of Thoracic Surgeons (STS) score,
ventricular reconstruction technique, and survival. Results Overall mortality of 14.7%, with hospital admission being 8.82% and late
death being 5.88%. Total survival rate at five years of 85.3%. In the
preoperative phase, NYHA FC was Class I in five patients, II in 18, III in
eight, and IV in three vs. NYHA FC Class I in 17 patients,
II in eight, III in six, and IV in three, in the postoperative period.
EuroSCORE II mean value was 6.29, P≤0.01; hazard
ratio (HR) 1.16 (95% confidence interval [CI] 1.02-1.31). STS
mortality/morbidity score mean value was 18.14,
P≤0.004; HR 1.19 (95% CI 1.05-1.33). Surgical
techniques showed no difference in survival among Dor 81%
vs. Jatene 91.7%. Conclusion Surgical treatment of left ventricular reconstruction in candidates for heart
transplantation is effective, efficient, and safe, providing adequate
survival.
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Affiliation(s)
- Carlos Alberto Méndez Contreras
- Instituto Dante Pazzanese de Cardiologia Division of Cardiovascular Surgery São Paulo SP Brazil Division of Cardiovascular Surgery of Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| | - Pedro Xavier Orellana
- Instituto Dante Pazzanese de Cardiologia Division of Cardiovascular Surgery São Paulo SP Brazil Division of Cardiovascular Surgery of Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| | - Antonio Flávio Sanchez de Almeida
- Instituto Dante Pazzanese de Cardiologia Division of Cardiovascular Surgery São Paulo SP Brazil Division of Cardiovascular Surgery of Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| | - Marco Aurélio Finger
- Instituto Dante Pazzanese de Cardiologia Division of Cardiovascular Surgery São Paulo SP Brazil Division of Cardiovascular Surgery of Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| | - João Manoel Rossi
- Instituto Dante Pazzanese de Cardiologia Division of Cardiovascular Surgery São Paulo SP Brazil Division of Cardiovascular Surgery of Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| | - Paulo Chaccur
- Instituto Dante Pazzanese de Cardiologia Division of Cardiovascular Surgery São Paulo SP Brazil Division of Cardiovascular Surgery of Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
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Isomura T, Hoshino J, Fukada Y, Kitamura A, Katahira S, Kondo T, Iwasaki T, Buckberg G. Volume reduction rate by surgical ventricular restoration determines late outcome in ischaemic cardiomyopathy. Eur J Heart Fail 2014; 13:423-31. [PMID: 21317149 DOI: 10.1093/eurjhf/hfq227] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tadashi Isomura
- Division of Cardiovascular Surgery; Hayama Heart Center; Hayama Japan
| | - Joji Hoshino
- Division of Cardiovascular Surgery; Hayama Heart Center; Hayama Japan
| | - Yasuhisa Fukada
- Division of Cardiovascular Surgery; Hayama Heart Center; Hayama Japan
| | - Aki Kitamura
- Division of Cardiovascular Surgery; Hayama Heart Center; Hayama Japan
| | - Shintaro Katahira
- Division of Cardiovascular Surgery; Hayama Heart Center; Hayama Japan
| | - Taichi Kondo
- Division of Cardiovascular Surgery; Hayama Heart Center; Hayama Japan
| | - Tomoaki Iwasaki
- Division of Cardiovascular Surgery; Hayama Heart Center; Hayama Japan
| | - Gerald Buckberg
- Division of Cardiovascular Surgery; David Geffen School of Medicine at UCLA; 10833 Le Conte Avenue, 62-258 CHS Los Angeles CA 90095 USA
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Mann DL, Bogaev R, Buckberg GD. Cardiac remodelling and myocardial recovery: lost in translation? Eur J Heart Fail 2014; 12:789-96. [DOI: 10.1093/eurjhf/hfq113] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Douglas L. Mann
- Division of Cardiology, Department of Medicine; Washington University; St Louis MO 63110 USA
| | - Roberta Bogaev
- Section of Cardiology, Department of Medicine; Baylor College of Medicine, St. Luke's Episcopal Hospital, Texas Heart Institute; Houston TX 77030 USA
| | - Gerald D. Buckberg
- Department of Cardiothoracic Surgery; David Geffen School of Medicine at UCLA; 10833 Le Conte Avenue, 62-258 CHS Los Angeles CA 90095 USA
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Buckberg GD, Athanasuleas CL, Wechsler AS, Beyersdorf F, Conte JV, Strobeck JE. The STICH trial unravelled. Eur J Heart Fail 2014; 12:1024-7. [PMID: 20861131 DOI: 10.1093/eurjhf/hfq147] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Gerald D. Buckberg
- Division of Cardiothoracic Surgery; David Geffen School of Medicine at UCLA; 62-258 CHS, 10833 Le Conte Avenue Los Angeles CA 90095 USA
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Suma H, Anyanwu AC. Current Status of Surgical Ventricular Restoration for Ischemic Cardiomyopathy. Semin Thorac Cardiovasc Surg 2012; 24:294-301. [DOI: 10.1053/j.semtcvs.2013.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2013] [Indexed: 11/11/2022]
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Abstract
Heart failure (HF) is an emerging epidemic affecting 15 million people in the USA and Europe. HF-related mortality was unchanged between 1995 and 2009, despite a decrease in the incidence of cardiovascular disease. Conventional explanations include an aging population and improved treatment of acute myocardial infarction and HF. An adverse relationship between structure and function is the central theme in patients with systolic dysfunction. The normal elliptical ventricular shape becomes spherical in ischemic, valvular, and nonischemic dilated cardiomyopathy. Therapeutic decisions should be made on the basis of ventricular volume rather than ejection fraction. When left ventricular end-systolic volume index exceeds 60 ml/m², medical therapy, CABG surgery, and mitral repair have limited benefit. This form-function relationship can be corrected by surgical ventricular restoration (SVR), which returns the ventricle to a normal volume and shape. Consistent early and late benefits in the treatment of ischemic dilated cardiomyopathy with SVR have been reported in >5,000 patients from various international centers. The prospective, randomized STICH trial did not confirm these findings and the reasons for this discrepancy are examined in detail. Future surgical options for SVR in nonischemic and valvular dilated cardiomyopathy, and its integration with left ventricular assist devices and cell therapy, are described.
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Isomura T. Surgical left ventricular reconstruction. Gen Thorac Cardiovasc Surg 2011; 59:315-25. [DOI: 10.1007/s11748-010-0742-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 11/07/2010] [Indexed: 11/24/2022]
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Shanmugam G, Ali IS. Surgical Ventricular Restoration: An Operation to Reverse Remodeling - Clinical Application (Part II). Curr Cardiol Rev 2010; 5:350-9. [PMID: 21037852 PMCID: PMC2842967 DOI: 10.2174/157340309789317913] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 08/11/2008] [Accepted: 08/11/2008] [Indexed: 12/04/2022] Open
Abstract
The first part of the article dealt with the basic science behind the evolution of ventricular restoration procedures and the rationale for the use of novel surgical techniques. The second part describes the preoperative workup of patients in advanced heart failure, the core information required to determine the surgical approach and the essential principles and techniques of ventricular restoration. It then examines the effects of ventricular restorative procedures on pump function and clinical outcomes, the results of the worldwide experience with ventricular restoration and concludes with more recent advances in this field.
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Affiliation(s)
- Ganesh Shanmugam
- Department of Surgery, Division of Cardiac Surgery, Dalhousie University, QEII Health Sciences Centre, Halifax Infirmary, 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada
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Hattori F, Fukuda K. Strategies for ensuring that regenerative cardiomyocytes function properly and in cooperation with the host myocardium. Exp Mol Med 2010; 26:223-32. [PMID: 20164677 DOI: 10.1016/j.trre.2011.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 03/21/2011] [Accepted: 09/02/2011] [Indexed: 11/18/2022] Open
Abstract
In developed countries, in which people have nutrient-rich diets, convenient environments, and access to numerous medications, the disease paradigm has changed. Nowadays, heart failure is one of the major causes of death. In spite of this, the therapeutic efficacies of medications are generally unsatisfactory. Although whole heart transplantation is ideal for younger patients with heart failure, many patients are deemed to be unsuitable for this type of surgery due to complications and/or age. The need for therapeutic alternatives to heart transplantation is great. Regenerative therapy is a strong option. For this purpose, several cell sources have been investigated, including intrinsic adult stem or progenitor cells and extrinsic pluripotent stem cells. Most intrinsic stem cells seem to contribute to a regenerative environment via paracrine factors and/or angiogenesis, whereas extrinsic pluripotent stem cells are unlimited sources of cardiomyocytes. In this review, we summarize the various strategies for using regenerative cardiomyocytes including our recent progressions: non-genetic approaches for the purification of cardiomyocytes and efficient transplantation. We expect that use of intrinsic and extrinsic stem cells in combination will enhance therapeutic effectiveness.
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Affiliation(s)
- Fumiyuki Hattori
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
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An indictment of the STICH trial: "True, true, and unrelated". J Heart Lung Transplant 2010; 29:491-6. [PMID: 20382350 DOI: 10.1016/j.healun.2009.12.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 12/16/2009] [Accepted: 12/16/2009] [Indexed: 11/20/2022] Open
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Almeida RMS. Quality of Life after 114 Months of Follow-up following Geometric Reconstruction of the Left Ventricle by Endoventriculoplasty with Septal Exclusion. Heart Surg Forum 2010; 13:E40-4. [DOI: 10.1532/hsf98.20091132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: The purpose of this study was to present the surgical experience of the Institute of Cardiovascular Surgery of West of Paran (ICCOP) with respect to the treatment of left ventricle aneurysms by endoventriculoplasty with septal exclusion (EVSE) and to evaluate the quality of life of these patients after a 114-month follow-up.Methods: Between April 1999 and April 2006, 28 patients underwent EVSE. Preoperative, transoperative, and late postoperative clinical and echocardiographic variables were analyzed retrospectively. In addition, latepostoperative quality of life was evaluated with questionnaire SF-36 (Brazilian version). The mean age (SD) of the group was 59.0 9.5 years, and 23 of the patients were male. Seventeen patients were in New York Heart Association functional class IV, and the mean preoperative EuroSCORE was 8.2 2.3. The mean preoperative values for the ejection fraction (EF) and the end-systolic and end-diastolic left ventricular volumes were 32.3% 9.2%, 113.9 36.0 mL, and 179.2 48.4 mL, respectively.Results: The in-hospital mortality rate was 14.3%, with the major causes of morbidity being low cardiac output syndrome and arrhythmias. The mean follow-up period was 5.9 3.4 years. The left ventricular EF and the aortic cross-clamping time were the significant factors for hospital and late mortality (P = .0222, and P = .0123, respectively). The actuarial survival curve showed survival rates of 82.1 7.2%, and 54.7 22.9%, before and after 107 months of follow-up. The overall score for the quality of life showed an improvement.Conclusion: EVSE surgery is an effective option for treating this group of patients, with improvement noted in left ventricular function and in the patients' quality of life, despite the high in-hospital mortality.
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Buckberg GD, Athanasuleas CL. The STICH trial: Misguided conclusions. J Thorac Cardiovasc Surg 2009; 138:1060-1064.e2. [DOI: 10.1016/j.jtcvs.2009.07.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 06/12/2009] [Accepted: 07/07/2009] [Indexed: 10/20/2022]
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Abstract
Congestive heart failure has become a major problem and the only surgical treatment for end-stage heart failure caused by dilated cardiomyopathy (DCM) had been heart transplantation. However, because of the shortage of donors, several procedures for non-transplant surgery have been developed. Published literature on left ventricular (LV) restoration was searched to review the new surgical procedures for treating patients with ischemic or non-ischemic DCM. LV restoration was initiated in the 1980s for repairing LV aneurysm. In the 1990s several surgical procedures were introduced for treating DCM, and the new evolving surgical treatment plays an important role in the management of DCM in the 21st century.
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Affiliation(s)
- Tadashi Isomura
- Cardiovascular Surgery, Hayama Heart Center, Hayama, Kanagawa 248-0116, Japan.
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Effects of surgical ventricular restoration on left ventricular contractility assessed by a novel contractility index in patients with ischemic cardiomyopathy. Am J Cardiol 2009; 103:674-9. [PMID: 19231332 DOI: 10.1016/j.amjcard.2008.10.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 10/31/2008] [Accepted: 10/31/2008] [Indexed: 11/22/2022]
Abstract
A pressure-normalized left ventricular (LV) wall stress (dsigma*/dt(max)) was recently reported as a load-independent index of LV contractility. We hypothesized that this novel contractility index might demonstrate improvement in LV contractile function after surgical ventricular restoration (SVR) using magnetic resonance imaging. A retrospective analysis of magnetic resonance imaging data of 40 patients with ischemic cardiomyopathy who had undergone coronary artery bypass grafting with SVR was performed. LV volumes, ejection fraction, global systolic and diastolic sphericity, and dsigma*/dt(max) were calculated. After SVR, a decrease was found in end-diastolic and end-systolic volume indexes, whereas LV ejection fraction increased from 26% +/- 7% to 31% +/- 10% (p <0.001). LV mass index and peak normalized wall stress were decreased, whereas the sphericity index (SI) at end-diastole increased, indicating that the left ventricle became more spherical after SVR. LV contractility index dsigma*/dt(max) improvement (from 2.69 +/- 0.74 to 3.23 +/- 0.73 s(-1), p <0.001) was associated with shape change as evaluated by the difference in SI between diastole and systole (r = 0.32, p <0.001, preoperative; r = 0.23, p <0.001, postoperative), but not with baseline LV SI. In conclusion, SVR excludes akinetic LV segments and decreases LV wall stress. Despite an increase in sphericity, LV contractility, as determined by dsigma*/dt(max), actually improves. A complex interaction of LV maximal flow rate and LV mass may explain the improvement in LV contractility after SVR. Because dsigma*/dt(max) can be estimated from simple noninvasive measurements, this underscores its clinical utility for assessment of contractile function with therapeutic intervention.
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Takeda K, Matsumiya G, Matsue H, Hamada S, Sakaki M, Sakaguchi T, Fujita T, Sawa Y. Use of quantitative analysis of remote myocardial fibrosis with delayed-enhancement magnetic resonance imaging to predict outcomes after surgical ventricular restoration for ischemic cardiomyopathy. J Thorac Cardiovasc Surg 2008; 136:1514-21. [DOI: 10.1016/j.jtcvs.2008.03.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2007] [Revised: 02/12/2008] [Accepted: 03/23/2008] [Indexed: 11/13/2022]
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Abstract
Ischemic cardiomyopathy affects an estimated 3 million people in the USA and is the most common cause of heart failure. Traditional operations have included heart transplantation, myocardial revascularization, mitral valve repair, left ventricular reconstruction, first-generation left ventricular assist devices and cardiac resynchronization therapy. These operations have become safer in recent times, due to improved technologies. Current technologies and surgical approaches can benefit a significant number of patients. However, there remains a large group of patients in whom traditional approaches can not be offered. Newer generation ventricular assist devices, passive ventricular restraint devices and cellular-based therapies (including skeletal- and bone marrow-derived stem cells) have the potential to be more universal in their applications. Ongoing investigations with each of these modalities will allow surgeons to offer treatment to patients who are not considered surgical candidates at this time.
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Affiliation(s)
- Gorav Ailawadi
- TCV Surgery, PO Box 800679, Charlottesville, VA 22908, USA.
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Gazoni LM, Kern JA, Swenson BR, Dent JM, Smith PW, Mulloy DP, Reece TB, Fedoruk LM, Lisle TC, Peeler BB, Kron IL. A Change in Perspective: Results for Ischemic Mitral Valve Repair Are Similar to Mitral Valve Repair for Degenerative Disease. Ann Thorac Surg 2007; 84:750-7; discussion 758. [PMID: 17720371 DOI: 10.1016/j.athoracsur.2007.04.098] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Revised: 04/20/2007] [Accepted: 04/23/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although the benefits of mitral valve repair for degenerative disease are well established, many consider surgery for functional ischemic mitral regurgitation (MR) less amenable to operative treatment. We hypothesized that mitral valve repair for ischemic MR results in outcomes similar to those for mitral valve repair for degenerative MR. METHODS Retrospective review of nonemergent mitral valve repairs for an 8-year period revealed 105 patients with functional ischemic MR, of whom 39 were treated for severe tethering (ischemic group), and 245 patients with degenerative MR (degenerative group). RESULTS Patients in the ischemic group had more comorbidities (p < 0.01) and worse preoperative left ventricular dysfunction (ejection fraction < or = 0.29) compared with patients in the degenerative group; (ischemic, 37.1% [39 of 105] versus degenerative, 2.0% [5 of 245]; p < 0.01). Immediate postrepair transesophageal echocardiogram revealed a 0 to 1+ MR in all patients in both groups (not significant). The hospital mortality rate was 1.9% (2 of 105) in the ischemic group and 1.2% (3 of 245) in the degenerative group (p = 1.00). The 5-year survival rate was 83.9% in the ischemic group and 94.3% in the degenerative group (p < 0.01). Five-year freedom from reoperation for recurrent MR was 100% and 97.5% in the ischemic and degenerative groups, respectively (p = 0.14). Postoperative renal failure and stroke rates were similar between both groups (not significant). The incidence of moderate or greater MR after more than 1 year of follow-up was similar between groups (not significant). CONCLUSIONS Despite the multiple comorbidities that afflict patients with ischemic MR, mitral valve repair for ischemic and degenerative disease produces comparable and satisfactory outcomes. An aggressive approach to repair of functional ischemic MR, including treatment of tethering, leads to durable results.
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Affiliation(s)
- Leo M Gazoni
- Department of Surgery, University of Virginia, Charlottesville, Virginia 22908, USA.
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Fedoruk LM, Tribble CG, Kern JA, Peeler BB, Kron IL. Predicting Operative Mortality After Surgery for Ischemic Cardiomyopathy. Ann Thorac Surg 2007; 83:2029-35; discussion 2035. [PMID: 17532391 DOI: 10.1016/j.athoracsur.2007.01.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 01/19/2007] [Accepted: 01/22/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND Ischemic cardiomyopathy accounts for as many as 70% of cases of heart failure with no clear algorithm for the treatment. We assessed the operative risks and mortality of various surgical options: coronary artery bypass grafting (CABG), CABG and mitral valve repair (CABG/MVR), and left ventricular remodeling (LVR) with or without CABG. We hypothesized that additional procedures increased the operative risk. We determined whether preoperative variables (eg, urgency of operation) impacted the surgical outcome. METHODS A retrospective analysis of University of Virginia patients from January 2000 until September 2006 was undertaken. Patients with CABG and an ejection fraction less than 35%, ischemic mitral regurgitation by operative characterization, and patients with LVR were identified. The Society of Thoracic Surgeons database risks, complications, and outcomes as well as degree of revascularization, quality of targets, and type of additional procedures were analyzed. Incomplete revascularization was defined as a planned bypass not performed. Poor targets were defined as per the operative note. RESULTS In all, 382 patients were identified (220 CABG, 97 CABG/MVR, and 65 LVR). The overall operative mortality was 7.9%. Mortality was 9.1% for CABG, 8.2% for CABG/MVR, and 3.1% for LVR. Preoperative risk factors for mortality included diabetes mellitus (p = 0.05), previous cerebrovascular disease (p = 0.05), and chronic renal dysfunction (p = 0.03). Patients with emergency operations had a significantly increased mortality (p < 0.001) as did patients with intra-aortic balloon pumps (p = 0.015). CONCLUSIONS Additional procedures such as MVR or LVR did not add to the operative risk of CABG for ischemic cardiomyopathy. Only preoperative comorbidities and emergency operations increased operative mortality.
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Affiliation(s)
- Lynn M Fedoruk
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia 22908-0679, USA.
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21
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Jones RH. The year in cardiovascular surgery. J Am Coll Cardiol 2007; 49:1887-98. [PMID: 17481449 DOI: 10.1016/j.jacc.2007.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 01/19/2007] [Accepted: 01/22/2007] [Indexed: 11/30/2022]
Abstract
This paper highlights information from cardiovascular surgical articles published in 2006 that are likely to have a broad impact on the practice of cardiovascular specialists in years ahead. Preference was given to articles that are innovative in purpose, thoughtful in design, and definitive in conclusions.
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Affiliation(s)
- Robert H Jones
- Department of Surgery/Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina 27715, USA.
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