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Kim MS, Lee JH, Kim EJ, Park DG, Park SJ, Park JJ, Shin MS, Yoo BS, Youn JC, Lee SE, Ihm SH, Jang SY, Jo SH, Cho JY, Cho HJ, Choi S, Choi JO, Han SW, Hwang KK, Jeon ES, Cho MC, Chae SC, Choi DJ. Korean Guidelines for Diagnosis and Management of Chronic Heart Failure. Korean Circ J 2017; 47:555-643. [PMID: 28955381 PMCID: PMC5614939 DOI: 10.4070/kcj.2017.0009] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/19/2017] [Accepted: 06/23/2017] [Indexed: 11/11/2022] Open
Abstract
The prevalence of heart failure (HF) is skyrocketing worldwide, and is closely associated with serious morbidity and mortality. In particular, HF is one of the main causes for the hospitalization and mortality in elderly individuals. Korea also has these epidemiological problems, and HF is responsible for huge socioeconomic burden. However, there has been no clinical guideline for HF management in Korea.
The present guideline provides the first set of practical guidelines for the management of HF in Korea and was developed using the guideline adaptation process while including as many data from Korean studies as possible. The scope of the present guideline includes the definition, diagnosis, and treatment of chronic HF with reduced/preserved ejection fraction of various etiologies.
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Affiliation(s)
- Min-Seok Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eung Ju Kim
- Department of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Dae-Gyun Park
- Division of Cardiology, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Joo Park
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Byung Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Sang Eun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang Hyun Ihm
- Department of Cardiology, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Se Yong Jang
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Hallym University Pyeongchon Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seonghoon Choi
- Division of Cardiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Woo Han
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Kyung Kuk Hwang
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eun Seok Jeon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myeong-Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Shung Chull Chae
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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Morimoto K, Kimura A, Nishimura K, Miyasaka S, Maeta H, Taniguchi I. Aortic valve replacement combined with the endoventricular patch technique for aortic valve stenosis complicated by ischemic heart disease. Ann Thorac Cardiovasc Surg 2011; 17:607-10. [PMID: 21881366 DOI: 10.5761/atcs.cr.10.01618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The indication for aortic valve replacement (AVR) combined left ventricular (LV) plasty in the patient with aortic valve stenosis (AS) complicated by ischemic heart disease is controversial. We describe a case of AS with ischemic heart disease of a patient who underwent a successful surgical treatment, AVR combined with the endoventricular patch technique. The patient was an 82-year-old woman who suffered from heart failure, New York Heart Association (NYHA) class III. The heart failure derived from AS and ischemic heart disease with severely compromised LV function. She underwent AVR combined with the endoventricular patch technique and the postoperative course was uneventful. She has been well with NYHA class I for about 5 years after the operation without heart failure.
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Affiliation(s)
- Keisuke Morimoto
- Department of Thoracic and Cardiovascular Surgery, Tottori Prefectural Central Hospital, 730 Ezu, Tottori, Japan.
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3
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Section 10: Surgical Approaches to the Treatment of Heart Failure. J Card Fail 2010. [DOI: 10.1016/j.cardfail.2010.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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4
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Baba S, Doi H, Ikeda T, Komeda M, Nakahata T. A long-term follow-up of a girl with dilated cardiomyopathy after mitral valve replacement and septal anterior ventricular exclusion. J Cardiothorac Surg 2009; 4:53. [PMID: 19775464 PMCID: PMC2758862 DOI: 10.1186/1749-8090-4-53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2008] [Accepted: 09/23/2009] [Indexed: 11/10/2022] Open
Abstract
We treated a 10 year 11 month old girl with severe mitral valve regurgitation, stenosis and dilated cardiomyopathy, presented with New York Heart Association (NYHA) functional classification IV. She acutely developed cardiogenic shock with a dyskinetic anterior-septal left ventricle and entered a shock state during our consultation about heart transplantation. Septal-anterior ventricular exclusion and mitral valve replacement were performed emergently. She successfully recovered from cardiogenic shock. Left ventricular end-diastolic diameter and fractional shortening improved from 71.5 mm (188.0% of normal) to 62.5 mm (144.2% of normal) and 7.6% to 18.3% respectively. Furthermore, her serum BNP decreased from 2217.5 pg/ml to 112.0 pg/ml. Her cardiac function has remained stable for 7 years since the procedures were performed.
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Affiliation(s)
- Shiro Baba
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
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Mollema SA, Klein P, Heersche J, Schalij MJ, Van der Wall EE, Versteegh MIM, Klautz RJM, Van Erven L, Bax JJ. Left ventricular ejection fraction as criterion for implantation of an implantable cardioverter-defibrillator in heart failure patients undergoing surgical left ventricular reconstruction. Pacing Clin Electrophysiol 2009; 32:913-7. [PMID: 19572868 DOI: 10.1111/j.1540-8159.2009.02408.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Besides implantation of an implantable cardioverter-defibrillator (ICD), a proportion of patients with left ventricular (LV) dysfunction due to ischemic cardiomyopathy are potential candidates for surgical LV reconstruction (Dor procedure), which changes LV ejection fraction (LVEF) considerably. In these patients, LVEF as selection criterium for ICD implantation may be difficult. This study aimed to determine the value of LVEF as criterium for ICD implantation in heart failure patients undergoing surgical LV reconstruction. METHODS Consecutive patients with end-stage heart failure who underwent ICD implantation and LV reconstruction were evaluated. During admission, two-dimensional (2D) echocardiography (LV volumes and LVEF) was performed before surgery and was repeated at 3 months after surgery. Over a median follow-up of 18 months, the incidence of ICD therapy was evaluated. RESULTS The study population consisted of 37 patients (59 +/- 11 years). At baseline, mean LVEF was 23 +/- 5%. Mean left ventricular end-systolic volume (LVESV) and left ventricular end-diastolic volume (LVEDV) were 175 +/- 73 mL and 225 +/- 88 mL, respectively. At 3-month follow-up, mean LVEF was 41 +/- 9% (P < 0.0001 vs. baseline), and mean LVESV and LVEDV were 108 +/- 65 mL and 176 +/- 73 mL, respectively (P < 0.0001 vs. baseline). During 18-month follow-up, 12 (32%) patients had ventricular arrhythmias, resulting in appropriate ICD therapy. No significant relations existed between baseline LVEF (P = 0.77), LVEF at 3-month follow-up (P = 0.34), change in LVEF from baseline to 3-month follow-up (P = 0.28), and the occurrence of ICD therapy during 18-month follow-up. CONCLUSION LVEF before and after surgical LV reconstruction is of limited use as criterium for ICD implantation in patients with end-stage heart failure.
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Affiliation(s)
- Sjoerd A Mollema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Wald RM, Haber I, Wald R, Valente AM, Powell AJ, Geva T. Effects of regional dysfunction and late gadolinium enhancement on global right ventricular function and exercise capacity in patients with repaired tetralogy of Fallot. Circulation 2009; 119:1370-7. [PMID: 19255342 DOI: 10.1161/circulationaha.108.816546] [Citation(s) in RCA: 191] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The underlying mechanisms that contribute to global right ventricular (RV) dysfunction in patients with repaired tetralogy of Fallot are incompletely understood. We therefore sought to quantify regional RV abnormalities and to determine the relationship of these to global RV function and exercise capacity. METHODS AND RESULTS Clinical and cardiac magnetic resonance data from 62 consecutive patients with repaired tetralogy of Fallot were analyzed (median age at follow-up 23 years [limits 9 to 67 years]). Using cardiac magnetic resonance data, 3D RV endocardial surface models were reconstructed from segmented contours, and a correspondence between end diastole and end systole was computed with a novel algorithm. Regional RV abnormalities were quantified and expressed as segmental ejection fraction, spatial extent of dyskinetic area, displacement of dyskinetic area, and score of extent of late gadolinium enhancement. Regional abnormalities of function and hyperenhancement were greatest in the RV outflow tract (RVOT). These regional RVOT abnormalities correlated with global RV ejection fraction: RVOT ejection fraction r=0.64, P<0.0001; RVOT dyskinetic area r=-0.51, P<0.0001; RVOT displacement of dyskinetic area r=-0.49, P<0.0001; and RVOT late gadolinium enhancement score r=-0.33, P=0.01. Peak oxygen consumption during exercise correlated best with RVOT ejection fraction (r=0.56, P=0.0002) compared with the remainder of the RV (r=0.35, P=0.03). The only cardiac magnetic resonance variable independently predictive of aerobic capacity was RVOT ejection fraction (P=0.02). CONCLUSIONS A greater extent of regional abnormalities in the RVOT adversely affects global RV function and exercise capacity after tetralogy of Fallot repair. These regional measures may have important implications for patient management, including RVOT reconstruction, at the time of pulmonary valve replacement.
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Affiliation(s)
- Rachel M Wald
- Department of Cardiology, Children's Hospital Boston and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
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7
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Kavarana MN, Abe J, Chitturi S, Kraftick R. Delayed rupture of the left ventricle inferior wall: a diagnostic and surgical challenge. J Card Surg 2008; 24:209-10. [PMID: 18793222 DOI: 10.1111/j.1540-8191.2008.00691.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An acute rupture after an acute myocardial infarction with an unusually delayed presentation is described. The etiology, factors contributing to the delayed presentation, diagnosis, and management are discussed.
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Affiliation(s)
- Minoo N Kavarana
- Department of Cardiothoracic Surgery, Marymount Hospital, London, Kentucky, USA.
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8
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Adult Heart Disease. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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9
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Unusual intraventricular flow pattern after left ventricular aneurysmorrhaphy. J Am Soc Echocardiogr 2007; 20:771.e7-8. [PMID: 17543752 DOI: 10.1016/j.echo.2006.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Indexed: 10/23/2022]
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10
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Surgical Treatment of Arrhythmias. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Dang NC, Cheema FH, Oz MC. Advances in heart failure surgery. Future Cardiol 2005; 1:257-67. [PMID: 19804170 DOI: 10.1517/14796678.1.2.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Heart failure is a major public health problem in the USA and in most Western countries. Nearly 5 million patients in the USA have heart failure with approximately 500,000 patients being diagnosed for the first time each year. Medical therapy is the first-line treatment, and surgery is considered when medical therapy fails or a clear mechanical cause of heart failure is identified and deemed correctable. Current surgical options include coronary revascularization, surgical correction of mitral regurgitation, left ventricular reconstruction, transmyocardial laser revascularization, ventricular assist devices, passive ventricular restraint devices, and cardiac transplantation. While a full discussion of cardiac transplantation is beyond the scope of this article, the other commonly performed procedures will be reviewed.
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Affiliation(s)
- Nicholas C Dang
- Department of Surgery , Columbia University College of Physicians and Surgeons, 630 West 168th Street, P&S Building, 17-415 New York, NY 10032, USA.
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13
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Mahon NG, O'Neill JO, Young JB, Bennett R, Hoercher K, Banbury MK, Navia JL, Smedira NG, McCarthy PM, Starling RC. Contemporary outcomes of outpatients referred for cardiac transplantation evaluation to a tertiary heart failure center: impact of surgical alternatives. J Card Fail 2004; 10:273-8. [PMID: 15309691 DOI: 10.1016/j.cardfail.2003.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The growing epidemic of congestive heart failure in the setting of limited donor-organ availability has mandated continued development and increased utilization of medical and surgical alternatives to cardiac transplantation. We sought to assess current disposition and outcomes of patients recently referred for transplant evaluation to a single high-throughput tertiary referral center. METHODS AND RESULTS We performed a retrospective observational review of consecutive patients with advanced heart failure who were assessed initially in an outpatient setting by a heart failure cardiologist, with a view to transplant or nontransplant surgical alternatives between 1995 and 2000. Of 1174 consecutive referrals (mean age 55.1 [+/-12.7], 74% male), 588 (50%) were recommended for medical treatment (mean age 55.3 [+/-12.4], 72% male) and 200 (17%) for nontransplant surgery, principally coronary artery bypass grafting, mitral valve repair, infarct exclusion, partial left ventriculectomy, or combinations thereof (mean age 57.8 [+/-10.6], 76% male). A minority, 418 (36%), were initially listed for cardiac transplantation (mean age 53.5 [+/-13.9], 80% male). Of these, 74 (18% of listed) died waiting (34 on left ventricular assist device support), 45 were delisted (27 for improved clinical status), and 217 (18% of referred group) have been transplanted. The 3-year survival (Kaplan-Meier) was equivalent (82%) in the transplanted and nontransplant surgery groups (excluding partial left ventriculectomy patients). CONCLUSION In current clinical practice less than one fifth of transplant referrals are ultimately transplanted, reflecting both a limited donor supply and the application of alternative, nontransplant strategies. Medium-term survival in patients suitable for alternative surgical strategies equals that of cardiac transplantation.
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Affiliation(s)
- Niall G Mahon
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Krishnamani R, El-Zaru M, DeNofrio D. Contemporary medical, surgical, and device therapies for end-stage heart failure. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2003; 5:487-499. [PMID: 14575626 DOI: 10.1007/s11936-003-0038-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Despite recent advances in medical therapy, mortality remains high following the diagnosis of heart failure (HF). Cardiac transplantation is still the standard surgical treatment option for highly selected patients with severe end-stage HF; however, it is only available to a small percentage of patients. The small number of available donor hearts is an inherent limitation on the ability of cardiac transplantation to greatly impact the management of advanced HF. The increased incidence and prevalence of HF in an ever aging and medically complex population has paved the way for alternative surgical and device treatment strategies. Some of these treatment options include ventricular reduction/remodeling surgery, mitral valve repair, mechanical ventricular assist device implantation, implantable cardioverter-defibrillators, and cardiac resynchronization therapy. Several recent trials have demonstrated the effectiveness of these therapies with regard to improvement in primary cardiac end points, HF symptoms, and survival. Surgical and device techniques are usually combined with optimal medical management of HF. The total cost and actual cost-effectiveness of employing these new therapeutic modalities in a growing population of HF patients remains to be determined.
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Affiliation(s)
- Rajan Krishnamani
- Cardiac Transplantation Program, Division of Cardiology, Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111, USA.
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15
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Kherani AR, Garrido MJ, Cheema FH, Naka Y, Oz MC. Nontransplant surgical options for congestive heart failure. CONGESTIVE HEART FAILURE (GREENWICH, CONN.) 2003; 9:17-24. [PMID: 12556673 DOI: 10.1111/j.1527-5299.2003.01695.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A wide array of surgical options are currently available for the treatment of congestive heart failure ranging from traditional coronary artery bypass grafting to total artificial heart implantation. The indications for each procedure depend on the severity of disease and the individual patients desires. Some surgical options are indicated for patients with moderate disease and prevent worsening heart failure, whereas other procedures are limited to patients who will only survive with high-risk surgery. Ongoing technologic advances are increasing the number of patients that benefit from the reparative surgical treatment of congestive heart failure.
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Affiliation(s)
- Aftab R Kherani
- Division of Cardiothoracic Surgery, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA.
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El-Zaru M, DeNofrio D. End-stage Heart Failure: Surgical Therapy and Implantable Devices. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2002; 4:511-520. [PMID: 12408792 DOI: 10.1007/s11936-002-0044-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite recent advances in medical therapy, mortality remains high following the diagnosis of heart failure (HF). Cardiac transplantation is still the standard surgical treatment option for highly selected patients with severe end-stage HF; however, it is available only to a small percentage of patients. The small number of available donor hearts is an inherent limitation on the ability of cardiac transplantation to greatly impact the management of advanced HF. The increased incidence and prevalence of HF in an ever aging and medically complex population has paved the way for alternative surgical and device treatment strategies. Some of these treatment options include ventricular reduction and remodeling surgery, mitral valve repair, mechanical ventricular assist device implantation, implantable cardioverter defibrillators, and cardiac resynchronization therapy. Several recent trials have demonstrated effectiveness of these therapies with regard to improvement in physiologic end points, HF symptoms, and survival. Surgical and device techniques are usually combined with optimal medical management of HF. The total cost and actual cost-effectiveness of employing these new therapeutic modalities in a growing population of HF patients remain to be determined.
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Affiliation(s)
- Mohamad El-Zaru
- Cardiac Transplantation Program, Tufts-New England Medical Center, Boston, MA 02021, USA.
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Ural E, Yüksel H, Pehlivanoglu S, Bakay C, Olga R. Short and long term survival of surgical treatment of left ventricular aneurysms: ten years experience. JAPANESE HEART JOURNAL 2002; 43:379-87. [PMID: 12227713 DOI: 10.1536/jhj.43.379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although surgical treatment of left ventricular aneurysms has been performed for a long time, it is still a point of debate. In this study, we investigated 159 patients who had undergone surgery for a left ventricular aneurysm in our clinic between 1985 and 1994. Perioperative mortality, long term survival rates, and parameters which probably affect these ratios were evaluated. All of the patients except one were followed by clinical records, mail or phone. Classic linear repair (111 cases), plication (46 cases), and Dor plasty (2 cases) were performed. Revascularisation procedure was also performed in 140 (88%) cases. The average number of distal anastomosis was 2.6. Twenty cases (12.6%) died in the perioperative period. The most important parameter which affected early mortality was the requirement for an intra-aortic balloon pump in the postoperative period. Mean follow-up duration was 47 +/- 35 months. Forty-two late deaths occurred in this period. The overall 5-year survival rate was 71%. Predictors for long term mortality were related to preoperative left ventricular function, presence of congestive heart failure, and poor functional capacity. The type of surgery did not affect short and long term survival. The functional capacity of the survivors was improved. In conclusion, surgical treatment of left ventricular aneurysms with classic linear repair and plication had acceptable short and long term survival rates and improved functional capacity. The most important predictor of survival in either the early or late postoperative period was preoperative left ventricular function.
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Affiliation(s)
- Ertan Ural
- Department of Cardiology, Kocaeli University Medical Faculty, Turkey
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18
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Tanaka H, Okishige K, Mizuno T, Kuriu K, Itoh F, Shimizu M, Akamatsu H, Tabuchi N, Arai H, Sunamori M. Temporary and permanent biventricular pacing via left ventricular epicardial leads implanted during primary cardiac surgery. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 2002; 50:284-9. [PMID: 12166267 DOI: 10.1007/bf03032296] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Biventricular pacing (BVP) is a new strategy for treating patients with severe congestive heart failure (CHF) and intraventricular conduction delay, but its full potential and technicalities of BVP require further evaluation. We evaluated BVP benefits in 4 patients in whom we implanted a left ventricular lead during primary cardiac surgery. METHODS Four CHF patients treated surgically between October 2000 and August 2001 underwent, at primary surgery, the implantation of leads in the right atrium, right ventricle, and left ventricle (LV) for postsurgical BVP. All patients had severe LV dysfunction and dilatation with intraventricular conduction delay. Surgeries involved CABG alone (n = 1), CABG + Dor's operation (n = 2), and tricuspid valve replacement + Maze procedure (n = 1). BVP was begun immediately after surgery in all 4 patients. Hemodynamic variables with BVP were compared to those without BVP for each patient, and the utility and technical aspects of implantation were evaluated. RESULTS BVP increased mean systemic blood pressure by 11% and mean LV stroke work index by 19% in the acute postsurgery period, and reduced mitral regurgitation. Two of the patients were implanted with a generator for permanent BVP, one at 1 month and the other at 6 months after surgery. The threshold of the LV epicardial lead of these 2 patients was below 2 V during follow-up, and BVP was successful. CONCLUSIONS Temporary BVP during the short-term after cardiac surgery improved cardiac function and decreased mitral regurgitation in all 4 of our patients. Epicardial lead implantation may thus be a useful option during surgical treatment of patients with CHF and intraventricular conduction delay if long-term permanent BVP is indicated.
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Affiliation(s)
- Hiroyuki Tanaka
- Department of Thoracic and Cardiovascular Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-0034, Japan
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Abstract
Heart failure is one of the leading causes of hospitalization in the United States. Congestive heart failure is a chronic, progressive disease and its central element is remodeling of the cardiac chamber associated with ventricular dilation. Secondary mitral regurgitation is a complication of end-stage cardiomyopathy and is associated with poor prognosis. Historically, these patients were not considered operative candidates because of their high morbidity and mortality. Heart transplantation is now considered standard treatment for select patients with end-stage heart disease; however, it is applicable only to a small number of patients. In an effort to address this problem, newer and alternative surgical approaches are evolving, including mitral valve annuloplasty, the Batista procedure, and other left ventricular shape changing technologies. Using these operative techniques to alter the shape of the left ventricle, in combination with optimal medical management for heart failure, improves survival, and patients may avoid or postpone transplantation.
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Affiliation(s)
- S F Bolling
- Section of Cardiac Surgery, Taubman Health Care Center, University of Michigan, Ann Arbor, Michigan 48109-0348, USA.
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Sawazaki M, Ito T, Yasuura K, Ogawa Y, Mizutani SI, Ishikawa H, Miura A, Hashizume R. Endoventricular Left Ventriculoplasty: Overlap Technique for Akinetic Scar. Asian Cardiovasc Thorac Ann 2000. [DOI: 10.1177/021849230000800404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Four patients were treated by endoventricular left ventriculoplasty with coronary artery bypass grafting. Three were elective cases and one had acute myocardial infarction. The overlap technique of left ventriculoplasty was employed in the 3 elective cases. An endoventricular circular suture was placed on the perimeter of the scar, the lateral free margin of the incision was sutured to the septum directly, and the margin of the septal side overlapped the anterior wall. In these 3 cases, end-diastolic volume index and end-systolic volume index were decreased and ejection fraction was increased postoperatively. It was concluded that coronary grafting combined with left ventriculoplasty using the overlap method was suitable for patients with ischemic heart disease and an akinetic scar.
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Affiliation(s)
| | - Toshiaki Ito
- Department of Surgery, Nagoya 1st Red Cross Hospital, Nagoya, Japan
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Abstract
Heart failure is one of the leading causes of hospitalization in the United States today. Congestive heart failure is a chronic progressive disease with the common central element being the remodeling of the cardiac chamber associated with ventricular dilation. Secondary mitral regurgitation is a complication of end-stage cardiomyopathy and is associated with a poor prognosis. Historically, these patients were not considered operative candidates due to the high morbidity and mortality in this patient population. Heart transplantation is now considered the standard of treatment for select patients with end-stage heart disease, however, it is only applicable to a small number of patients. In an effort to address this problem, newer and alternative surgical approaches are evolving, including mitral valve annuloplasty, the Batista myoplasty, and cardiomyoplasty. When these operative techniques that alter the shape of the left ventricle are utilized, in combination with optimal medical management for heart failure, survival is improved and patients can avoid or postpone transplantation.
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Affiliation(s)
- I A Smolens
- Section of Cardiac Surgery, University of Michigan, Taubman Health Care Center, 2120D, Box 0348, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0348, USA
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