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Babokin V. Left Ventricular Reconstruction With Thrombectomy. Ann Thorac Surg 2020; 111:1737-1738. [PMID: 33875139 DOI: 10.1016/j.athoracsur.2020.07.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/09/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Vadim Babokin
- Cardiovascular Surgery Department, Institute of Cardiology, Tomsk, Russia; Republic Cardiac Dispensary, 29 Gladkova Str, Bld A, Cheboksary, Chuvash Republic, 428020, Russia.
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Shipulin VM, Pryakhin AS, Andreev SL, Shipulin VV, Kozlov BN. [Surgical Treatment of Ischemic Cardiomyopathy: Current State of the Problem]. ACTA ACUST UNITED AC 2019. [PMID: 31540578 DOI: 10.18087//cardio.2019.9.n329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this article we present discussion of the current state of the problem of surgical treatment of ischemic cardiomyopathy (ICM). The pathophysiological aspects of left ventricular remodeling in patients with ICM are also covered. A detailed characterization of methods for assessing the myocardial viability is given and their role in patients with ICM is shown. The problem of right ventricular dysfunction in ICM is discussed. Main attention is focused on the methods of surgical treatment of ICM. Limitations of the Surgical Treatment for Ischemic Heart Failure (STICH) study are analyzed. The article is intended for cardiologists, general practitioners and cardiac surgeons.
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Affiliation(s)
- V M Shipulin
- Сardiology Research Institute, Tomsk National Research Medical Centre, Siberian State Medical University
| | - A S Pryakhin
- Сardiology Research Institute, Tomsk National Research Medical Centre
| | - S L Andreev
- Сardiology Research Institute, Tomsk National Research Medical Centre
| | - V V Shipulin
- Сardiology Research Institute, Tomsk National Research Medical Centre
| | - B N Kozlov
- Сardiology Research Institute, Tomsk National Research Medical Centre, Siberian State Medical University
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3
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Significance of preoperative right ventricular function on mid-term outcomes after surgical ventricular restoration for ischemic cardiomyopathy. Gen Thorac Cardiovasc Surg 2019; 67:925-933. [DOI: 10.1007/s11748-019-01123-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
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4
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Wakasa S, Matsui Y, Kobayashi J, Cho Y, Yaku H, Matsumiya G, Isomura T, Takanashi S, Usui A, Sakata R, Komiya T, Sawa Y, Saiki Y, Shimizu H, Yamaguchi A, Hamano K, Arai H. Estimating postoperative left ventricular volume: Identification of responders to surgical ventricular reconstruction. J Thorac Cardiovasc Surg 2018; 156:2088-2096.e3. [DOI: 10.1016/j.jtcvs.2018.06.090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 06/19/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
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5
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Kitamura M, Schmidt T, Kuck KH, Frerker C. Heart Failure Interventions Targeting Impaired Left Ventricles in Structural Heart Disease. Curr Cardiol Rep 2018; 20:8. [PMID: 29435772 DOI: 10.1007/s11886-018-0950-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW Interventional techniques have been developed for a wide spectrum of mechanisms of heart failure (HF), especially in valvular heart disease and cardiomyopathies (ischaemic cardiomyopathy and hypertrophic cardiomyopathy). In this article, we review recent reports on catheter interventions to treat patients with HF. RECENT FINDINGS Direct modification using the Parachute device and the REVIVENT-TC device for patients with impaired left ventricle with large infarct scars improves geometry and haemodynamic efficiency, resulting in a reduction of HF symptoms. Interatrial shunt therapy improves symptoms and quality of life in HF patients. Uniquely, left ventricular outflow tract obstruction has also been targeted in patients with transcatheter mitral valve implantation. For advanced stage HF patients with prohibitively high surgical risk, emerging transcatheter interventions make it possible to modify life-limiting symptoms. Further results on HF interventions are expected from ongoing clinical trials.
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Affiliation(s)
- Mitsunobu Kitamura
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
| | - Tobias Schmidt
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
| | - Christian Frerker
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany.
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6
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Jia G, Zao M, Liu X. Protective effect of diethylcarbamazine inhibits NF-κB activation in isoproterenol-induced acute myocardial infarction rat model through the PARP pathway. Mol Med Rep 2017; 16:1596-1602. [PMID: 28586070 DOI: 10.3892/mmr.2017.6695] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/10/2017] [Indexed: 11/05/2022] Open
Abstract
The present study investigated the protective effect of diethylcarbamazine in inhibiting nuclear factor (NF)-κB activation in isoproterenol‑induced acute myocardial infarction (AMI) rats through the poly ADP ribose polymerase (PARP) pathway. Male albino Wistar rats were injected subcutaneously with isoproterenol (100 mg/kg/day) for 2 days to induce an AMI model. Diethylcarbamazine (50 mg/kg) was administered by gavage for 12 days prior to the isoproterenol-induced AMI. It was noted that diethylcarbamazine significantly inhibited AMI‑induced casein kinase and lactate dehydrogenase levels, and reduced the AMI‑induced wet heart weight to body weight ratio in AMI rats. Diethylcarbamazine treatment significantly weakened reactive oxygen species production and reduced the levels of tumor necrosis factor (TNF)‑α, interleukin‑6 and NF‑κB/p65 in AMI rats. Western blotting demonstrated that diethylcarbamazine significantly suppressed the AMI‑induced inducible nitric oxide synthase (iNOS), transforming growth factor (TGF)‑β1, cyclooxygenase‑2 (COX‑2) and PARP protein expression in AMI rats. The results demonstrated that the protective effect of diethylcarbamazine inhibited isoproterenol‑induced AMI through the suppression of inflammation, iNOS, TGF‑β1, COX‑2 and the PARP pathway, and revealed the clinical potential of diethylcarbamazine for therapeutic and clinical applications.
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Affiliation(s)
- Guowei Jia
- Department of Cardiovascular Internal Three, Cangzhou Central Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Ming Zao
- Department of Cardiovascular Internal Three, Cangzhou Central Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Xiaoyu Liu
- Department of Cardiovascular Internal Three, Cangzhou Central Hospital, Cangzhou, Hebei 061000, P.R. China
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7
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Effect of preoperative left ventricular diastolic dysfunction on mid-term outcomes after surgical ventricular restoration for ischemic cardiomyopathy. Gen Thorac Cardiovasc Surg 2017; 65:381-387. [DOI: 10.1007/s11748-017-0773-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/26/2017] [Indexed: 10/19/2022]
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8
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Asai H, Shingu Y, Yamakawa T, Niwano H, Wakasa S, Ooka T, Kato H, Tachibana T, Matsui Y. Left-Ventricular Plication Reduces Wall Stress and Cardiomyocyte Hypertrophy in a Rat Model of Ischemic Cardiomyopathy. Eur Surg Res 2016; 58:69-80. [PMID: 27884008 DOI: 10.1159/000452682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/23/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The indications of left-ventricular plication (LVP) are controversial, although several studies have reported favorable outcomes in heart failure patients. The aim of this study was to assess left-ventricular (LV) wall stress and myocardial remodeling after LVP in a rat model of myocardial infarction (MI). METHODS Sixteen rats underwent LVP by excluding the LV anterior wall scar 4 weeks after ligation of the left anterior descending artery. After 4 weeks, LV wall stress was assessed using transthoracic echocardiography and an LV catheter. Gene expression of the wall stress markers, atrial natriuretic factor (ANF) and brain natriuretic peptide (BNP), were evaluated via reverse transcription polymerase chain reaction. Cardiomyocyte area and myocardial fibrosis were also examined through histological examinations. These parameters were compared to those in 16 rats that underwent coronary artery ligation but not LVP. RESULTS We noted that the LV end-diastolic dimension was smaller (9.9 ± 0.3 vs. 11.2 ± 0.2 mm, p < 0.05) and fractional shortening was greater (25 ± 2 vs. 15 ± 1%, p < 0.05) in LVP rats than in sham rats. Moreover, systolic wall stress was lower in LVP rats (71 ± 7 vs. 111 ± 9 × 103 dyn/cm2, p < 0.05). Myocardial ANF and BNP expression levels were lower in LVP rats (2.6 ± 0.3 vs. 4.4 ± 0.5 and 1.0 ± 0.1 vs. 1.5 ± 0.2 arbitrary units, respectively; p < 0.05). Cardiomyocyte area was significantly decreased in LVP rats (556 ± 15 vs. 670 ± 28 μm2, p = 0.003) and was correlated with LV wall stress (r = 0.669, p = 0.002). The reduction in myocardial fibrosis after LVP was not significant. CONCLUSION LVP reduced LV wall stress and cardiomyocyte hypertrophy in a rat model of MI.
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Affiliation(s)
- Hidetsugu Asai
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Janaswamy P, Walters TE, Nazer B, Lee RJ. Current Treatment Strategies for Heart Failure: Role of Device Therapy and LV Reconstruction. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:57. [PMID: 27488313 DOI: 10.1007/s11936-016-0479-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OPINION STATEMENT Medical care of heart failure (HF) begins with the determination of the cause of the heart failure and diagnosing potential reversible causes (i.e., coronary heart disease, hyperthyroidism, etc.). Medical therapy includes pharmacological and nonpharmacological strategies that limit and/or reverse the signs and symptoms of HF. Initial behavior modification includes dietary sodium and fluid restriction to avoid weight gain; and encouraging physical activity when appropriate. Optimization of medical therapy is the first line of treatment that includes the use of diuretics, vasodilators (i.e., ACE inhibitors or ARBs), beta blockers, and potentially inotropic agents and anticoagulation depending on the patient's severity of heart failure and LV dysfunction. As heart failure advances despite optimized medical management, cardiac resynchronization therapy (CRT), and implantable cardioverter defibrillators (ICDs) are appropriate device therapies. The development of progressive end-stage HF, despite maximal medical therapy, necessitates the consideration of mechanical circulatory devices such as ventricular assist devices (VADs) either as a bridge to heart transplantation or as destination therapy. Despite the advances in the treatment of heart failure, there is still a large morbidity and mortality associated with HF, thus the need to develop newer strategies for the treatment of HF.
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Affiliation(s)
- Praneeth Janaswamy
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Tomos E Walters
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Babak Nazer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Randall J Lee
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA. .,Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA. .,Institute for Regeneration Medicine, University of California San Francisco, San Francisco, CA, USA. .,University of California San Francisco, Box 1354, San Francisco, CA, 94143, USA.
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10
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Affiliation(s)
- S Westaby
- Oxford Heart Centre, John Radcliffe Hospital, Department of Cardiothoracic Surgery, Oxford, UK.
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New Insights in the Diagnosis and Treatment of Heart Failure. BIOMED RESEARCH INTERNATIONAL 2015; 2015:265260. [PMID: 26634204 PMCID: PMC4637457 DOI: 10.1155/2015/265260] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/21/2015] [Indexed: 12/22/2022]
Abstract
Cardiovascular disease is the leading cause of mortality in the US and in westernized countries with ischemic heart disease accounting for the majority of these deaths. Paradoxically, the improvements in the medical and surgical treatments of acute coronary syndrome are leading to an increasing number of “survivors” who are then developing heart failure. Despite considerable advances in its management, the gold standard for the treatment of end-stage heart failure patients remains heart transplantation. Nevertheless, this procedure can be offered only to a small percentage of patients who could benefit from a new heart due to the limited availability of donor organs. The aim of this review is to evaluate the safety and efficacy of innovative approaches in the diagnosis and treatment of patients refractory to standard medical therapy and excluded from cardiac transplantation lists.
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12
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Castelvecchio S, Menicanti L. Left ventricular reconstruction: update to left ventricular aneurysm/reshaping techniques. Multimed Man Cardiothorac Surg 2015; 2013:mmt002. [PMID: 24413001 DOI: 10.1093/mmcts/mmt002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The increase in left ventricular (LV) volume after a myocardial infarction (MI) is a component of the remodelling process and is associated with a poor clinical outcome. Hence, the current management strategy for ischaemic LV dysfunction has been aimed at reversing the remodelling process. Surgical LV reconstruction (LVR) has been introduced as an optional therapeutic strategy aimed at reducing LV volumes through the exclusion of the scar tissue, thereby restoring the physiological volume and shape and improving LV function and clinical status. Until recently, several studies have shown that surgical LVR is effective and relatively safe, with a favourable 5-year outcome. However, in spite of the large amount of reports drawn on various data sets, the additional benefit of LVR to CABG remains debated. We briefly discuss the rationale for surgically reversing LV remodelling through LVR, and, more extensively, the technique and the indications to the best of our knowledge.
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13
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Nipro extra-corporeal left ventricular assist device fitting after left ventricular reconstruction with mitral valve plasty. J Artif Organs 2015; 18:361-4. [PMID: 25971993 DOI: 10.1007/s10047-015-0837-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Abstract
Both left ventricular assist device and left ventricular reconstruction are treatment choices for severe heart failure conditions. Our institution performed a left ventricular assist device installation following a left ventricular reconstruction procedure on a 42-year-old male patient who presented with dilated cardiomyopathy and low cardiac output syndrome. A mitral valve plasty was used to correct the acute mitral valve regurgitation and we performed a Nipro extra-corporeal left ventricular assist device installation on post-operative day 14. Due to the left ventricular reconstruction that the patient had in a previous operation, we needed to attach an apical cuff on posterior apex, insert the inflow cannula with a large curve, and shift the skin insertion site laterally to the left. We assessed the angle between the cardiac longitudinal axis and the inflow cannula using computed tomography. The patient did not complain of any subjective symptoms of heart failure. Although Nipro extra-corporeal left ventricular assist device installation after left ventricular reconstruction has several difficulties historically, we have experienced a successful case.
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14
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Wakasa S, Shingu Y, Ooka T, Katoh H, Tachibana T, Matsui Y. Surgical strategy for ischemic mitral regurgitation adopting subvalvular and ventricular procedures. Ann Thorac Cardiovasc Surg 2015; 21:370-7. [PMID: 25740449 DOI: 10.5761/atcs.oa.14-00204] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The progression of left ventricular (LV) remodeling and subsequent mitral valve tethering impair the results of reduction annuloplasty for ischemic mitral regurgitation (MR). METHODS We studied 90 patients who underwent surgical repair of ischemic MR between 1999 and 2013 according to our surgical strategy adding submitral and ventricular procedures to annuloplasty as follows: annuloplasty alone (stage 1, n = 30), additional papillary muscle approximation (PMA) for progression of tethering (stage 2, n = 26), and additional left ventriculoplasty with PMA for progression of LV remodeling and tethering (stage 3, n = 34). RESULTS The preoperative New York Heart Association (NYHA) functional classes (2.5 ± 0.7, 3.1 ± 0.7 and 3.3 ± 0.7 for stages 1, 2 and 3, respectively, P <0.001), LV end-diastolic diameters (56 ± 7 mm, 66 ± 5 mm and 70 ± 7 mm, P <0.001), and LV ejection fractions (45 ± 12%, 32 ± 9% and 27 ± 9%, P <0.001) significantly differed among the stages. In contrast, the MR grades did not significantly differ (2.9 ± 0.8, 3.0 ± 1.0, and 2.9 ± 1.1, respectively; P = 0.93). Both the rates of cardiac-related survival and freedom from reoperation were comparable among the 3 groups (log-rank P = 0.92 and 0.58, respectively). CONCLUSION Additional submitral and ventricular procedures can compensate for the possible impairment of the outcomes after annuloplasty alone for ischemic MR in patients with severe LV remodeling and tethering.
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Affiliation(s)
- Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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15
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Velazquez EJ, Bonow RO. Revascularization in Severe Left Ventricular Dysfunction. J Am Coll Cardiol 2015; 65:615-24. [DOI: 10.1016/j.jacc.2014.10.070] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 10/07/2014] [Indexed: 01/04/2023]
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16
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Risk scores for predicting mortality after surgical ventricular reconstruction for ischemic cardiomyopathy: Results of a Japanese multicenter study. J Thorac Cardiovasc Surg 2014; 147:1868-74, 1874.e1-2. [DOI: 10.1016/j.jtcvs.2013.06.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 05/02/2013] [Accepted: 06/27/2013] [Indexed: 11/21/2022]
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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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Liu J, Liu Z, Zhao Q, Chen A, Wang Z, Zhu D. Role of Surgical Ventricular Restoration in the Treatment of Ischemic Cardiomyopathy. Ann Thorac Surg 2013; 95:1315-21. [DOI: 10.1016/j.athoracsur.2012.12.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 12/06/2012] [Accepted: 12/07/2012] [Indexed: 12/01/2022]
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Wakasa S, Matsui Y, Isomura T, Takanashi S, Yamaguchi A, Komiya T, Cho Y, Kobayashi J, Yaku H, Kokaji K, Arai H, Sawa Y. Impact of left ventricular remodelling on outcomes after left ventriculoplasty for ischaemic cardiomyopathy: Japanese surgical ventricular reconstruction group experience. Interact Cardiovasc Thorac Surg 2013; 16:785-91. [PMID: 23475121 DOI: 10.1093/icvts/ivt096] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Surgical ventricular reconstruction (SVR) for patients with severe left ventricular (LV) remodelling due to ischaemic cardiomyopathy is still controversial, because the Surgical Treatment for Ischaemic Heart Failure (STICH) trial demonstrated that SVR not only has no beneficial effect on survival compared with coronary artery bypass grafting (CABG) alone, but also is worse for those with a larger LV. Therefore, we assessed the impact of LV remodelling on the outcomes after SVR for ischaemic cardiomyopathy in Japan, using Di Donato's LV shape classification. METHODS From 2000 to 2010, 627 patients underwent SVR for ischaemic heart failure in 11 Japanese hospitals. To assess the patients with an LV ejection fraction (LVEF) of ≤ 35% like the STICH trial, considering the severity of LV remodelling, the patients with a preoperative LVEF of >35%, no preoperative LV volume assessment and no preoperative LV shape classification were excluded. Finally, 323 patients were selected as the study subjects. The LV shape was divided into three types according to Di Donato's classification. Types 1 and 3 indicate the aneurysmal and globally akinetic LV, respectively. Type 2 is the intermediate shape. RESULTS Type 1, 2 and 3 LV shapes were observed in 85 (26%), 104 (32%) and 134 (42%) of the patients, respectively. The preoperative LV volume and diameter increased if the LV became more akinetic (Type 3 > 2 > 1, P < 0.001). LVEF was lower in those with more akinetic LV (P = 0.002). The preoperative LV end-diastolic volume index and LVEF in Type 3 patients were 133 ± 47 ml/m(2) and 22 ± 7%, respectively. Mitral valve repair was more frequently performed for patients with the Type 3 LV shape (65%) than for the others (P < 0.001). The hospital mortality rates were 2.4, 2.9 and 7.4% for Type 1, 2 and 3 patients, respectively (P = 0.16). Kaplan-Meier analysis demonstrated no significant difference in mortality among the three groups (log-rank P = 0.37). The 5-year survival rates were 81, 70 and 73% for Type 1, 2 and 3 patients, respectively. CONCLUSIONS The severity of LV remodelling did not affect survival after SVR plus CABG. The results of SVR were acceptable even for those with globally akinetic LV due to ischaemic cardiomyopathy.
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Affiliation(s)
- Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Goh S, Prior D, Newcomb A, McLellan A, Mack J, Callaghan S, Dimitriou J, Rosalion A, Nixon I, Yii M. Surgical Ventricular Restoration Procedure: Single-Center Comparison of Surgical Treatment of Ischemic Heart Failure (STICH) Versus Non-STICH Patients. Ann Thorac Surg 2013; 95:506-12. [DOI: 10.1016/j.athoracsur.2012.10.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 10/14/2012] [Accepted: 10/16/2012] [Indexed: 12/01/2022]
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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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Jeganathan R, Maganti M, Badiwala MV, Rao V. Concomitant mitral valve surgery in patients undergoing surgical ventricular reconstruction for ischaemic cardiomyopathy. Eur J Cardiothorac Surg 2012; 43:1000-5. [DOI: 10.1093/ejcts/ezs499] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bonow RO. Surgical ventricular reconstruction for heart failure: is there life after STICH? JACC Cardiovasc Imaging 2011; 4:771-3. [PMID: 21757168 DOI: 10.1016/j.jcmg.2011.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 06/01/2011] [Indexed: 10/18/2022]
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Castelvecchio S, Menicanti L, Donato MD. Surgical ventricular restoration to reverse left ventricular remodeling. Curr Cardiol Rev 2011; 6:15-23. [PMID: 21286274 PMCID: PMC2845790 DOI: 10.2174/157340310790231626] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 03/06/2009] [Accepted: 03/15/2009] [Indexed: 12/14/2022] Open
Abstract
Heart failure is one of the major health care issues in the Western world. An increasing number of patients are affected, leading to a high rate of hospitalization and high costs. Even with administration of the best available medical treatment, mortality remains high. The increase in left ventricular volume after a myocardial infarction is a component of the remodeling process. Surgical Ventricular Restoration (SVR) has been introduced as an optional therapeutic strategy to reduce left ventricular volume and restore heart geometry. So far, it has been established that SVR improves cardiac function, clinical status, and survival in patients with ischemic, dilated cardiomyopathy and heart failure. Since its first description , SVR has been refined in an effort to standardize the procedure and to optimize the results. This review will discuss the rationale behind surgical reversal of LV remodeling, the SVR technique, its impact on cardiac function and survival, and future expectations.
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Castelvecchio S, Menicanti L, Donato MD. Cirugía de restauración ventricular para revertir el remodelado del ventrículo izquierdo. CIRUGIA CARDIOVASCULAR 2011. [DOI: 10.1016/s1134-0096(11)70052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Di Donato M, Fantini F, Toso A, Castelvecchio S, Menicanti L, Annest L, Burkhoff D. Impact of surgical ventricular reconstruction on stroke volume in patients with ischemic cardiomyopathy. J Thorac Cardiovasc Surg 2010; 140:1325-31.e1-2. [PMID: 20381078 DOI: 10.1016/j.jtcvs.2010.01.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 12/30/2009] [Accepted: 01/18/2010] [Indexed: 10/19/2022]
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Shanmugam G, Ali IS. Surgical ventricular restoration: an operation to reverse remodeling - the basic science (part I). Curr Cardiol Rev 2010; 5:343-9. [PMID: 21037851 PMCID: PMC2842966 DOI: 10.2174/157340309789317878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/26/2022] Open
Abstract
Congestive heart failure as a consequence of ischemic heart disease is an increasing medical problem. Notwithstanding the huge advances in the medical and conventional surgical management of heart failure, eventual outcomes remain suboptimal. This 2 part article outlines the magnitude of the problem, the limitations of conventional therapies as they exist, and the use of newer procedures that directly address the restoration of ventricular pump function. The first part of the article deals with the pathology of different facets of the remodeling process, and the unique anatomy, geometry and flow dynamics as they pertain to ventricular function in the normal as well as the failing heart. It then details the limitations of conventional therapy, thereby laying the basis for the need and evolution of newer surgical procedures and ends with the selection of patients for ventricular restoration procedures and the pitfalls in the choice of patients for such newer techniques.
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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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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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Di Donato M, Castelvecchio S, Menicanti L. End-systolic volume following surgical ventricular reconstruction impacts survival in patients with ischaemic dilated cardiomyopathy. Eur J Heart Fail 2010; 12:375-81. [PMID: 20185429 DOI: 10.1093/eurjhf/hfq020] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS A left ventricular end-systolic volume (LVESV) > or =60 mL/m(2) has been shown to be associated with increased cardiac mortality after a reperfused myocardial infarction (MI). The reduction in LVESV following surgical ventricular reconstruction (SVR) is reported to be between 19% and 50% but its impact on prognosis is not well-established. The aim of this study was therefore to assess the impact on survival of a residual LVESV index (LVESVI) of > or = or <60 mL/m(2) following SVR. METHODS AND RESULTS All patients undergoing SVR at our Centre between July 2001 and March 2009 were eligible to be included in this study if they had a preoperative LVESVI of > or =60 mL/m(2) and an LVESVI measurement performed at discharge (7-10 days after surgery). Two hundred and sixteen patients (aged 64 +/- 9 years, 33 women) satisfied these criteria. Coronary artery bypass graft was performed in 197 patients (91.2%) and mitral repair in 63 patients (29%). Left ventricular ESVI had decreased by 41% at discharge in the overall population. Patients were grouped according to the residual LVESVI at discharge as follows: Group 1, LVESVI > or = 60 mL/m(2) (n = 71), and Group 2, LVESVI < 60 mL/m(2) (n = 145). In both groups, LVESVI decreased significantly with respect to baseline, by 29% in Group 1 and by 47% in Group 2. At multivariate analysis, the presence of a non-Q-wave MI and a preoperative internal diastolic diameter of 65 mm were the strongest predictors of a residual post-operative LVESVI of > or =60 mL/m(2). Risk of all-cause death was significantly higher in Group 1. Post-operative LVESVI of > or =60 mL/m(2) was an independent predictor of mortality at follow-up [Exp(B) = 10.7, CI: 2.67-42.9, P = 0.001]. CONCLUSION Our findings confirm the role of LVESVI in predicting survival following SVR; the lack of additional improvement in survival with SVR observed in the STICH trial might be due to the inadequate volume reduction (-19%).
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Affiliation(s)
- Marisa Di Donato
- Department of Critical Care Medicine, University of Florence, Florence, Italy.
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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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Dzemali O, Risteski P, Bakhtiary F, Singer E, Zierer A, Kleine P, Moritz A. Surgical left ventricular remodeling leads to better long-term survival and exercise tolerance than coronary artery bypass grafting alone in patients with moderate ischemic cardiomyopathy. J Thorac Cardiovasc Surg 2009; 138:663-8. [PMID: 19698853 DOI: 10.1016/j.jtcvs.2009.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Revised: 12/12/2008] [Accepted: 02/01/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Optimal treatment strategies for patients with ischemic cardiomyopathy and moderately reduced left ventricular function remain controversial. We assessed the early and midterm outcomes after surgical revascularization alone versus revascularization and additional left ventricular remodeling in these patients. METHODS Between 2000 and 2003, 285 consecutive patients with coronary artery disease and moderately impaired left ventricular function (ejection fraction 30%-40%) were surgically treated with coronary artery bypass grafting alone (group 1, n = 165) or open left ventricular remodeling in addition to revascularization (group 2, n = 120). Preoperatively, the New York Heart Association class, left ventricular ejection fraction, and end-diastolic diameter were comparable. Early and midterm outcomes, hemodynamic performance, and quality of life assessed by Minnesota Quality of Life Questionnaire were evaluated during a mean follow-up period of 70 months. RESULTS Group 2 patients demonstrated significantly longer ventilation times, higher blood loss, and need for blood transfusion but had significantly lower operative mortality (4.5% compared with 8.5% in group 1). Seven-year follow-up demonstrated survival of 74.3% +/- 8.1% in group 1 versus 84.2% +/- 5.4% in group 2 (P < .05). Follow-up examinations revealed greater improvement of functional class in group 1 with mean 1.7 +/- 0.7 versus 2.03 +/- 0.8 in group 2 (P < .05). Cardiac-related hospital readmissions were comparable (3.8% vs 4.1%, P = .73). CONCLUSIONS Patients with ischemic cardiomyopathy, in whom surgical ventricular remodeling was possible and performed, experienced more perioperative complications but had superior early and midterm outcome regarding survival, functional class, and quality of life.
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Affiliation(s)
- Omer Dzemali
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
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Affiliation(s)
- Yoshiro Matsui
- Department of Cardiovascular Surgery, Hokkaido University Hospital
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Comas GM, Esrig BC, Oz MC. Surgery for myocardial salvage in acute myocardial infarction and acute coronary syndromes. Heart Fail Clin 2007; 3:181-210. [PMID: 17643921 DOI: 10.1016/j.hfc.2007.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This article addresses the pathophysiology, the treatment options, and their rationale in the setting of life-threatening acute myocardial infarction and acute on chronic ischemia. Although biases may exist between cardiologists and surgeons, with this review, we hope to provide the reader with information that will shed light on the options that best suit the individual patient in a given set of circumstances.
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Affiliation(s)
- George M Comas
- College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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Pocar M, Moneta A, Grossi A, Donatelli F. Coronary Artery Bypass for Heart Failure in Ischemic Cardiomyopathy: 17-Year Follow-Up. Ann Thorac Surg 2007; 83:468-74. [PMID: 17257971 DOI: 10.1016/j.athoracsur.2006.09.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Revised: 09/03/2006] [Accepted: 09/06/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) has been safely extended to ischemic cardiomyopathy and heart failure, but outcome beyond 5 years remains poorly defined. METHODS We retrospectively analyzed 45 consecutive angina-free patients with ischemic left ventricular dysfunction (ejection fraction < or = 0.35) and heart failure (New York Heart Association functional class III to IV) who were selected for CABG between 1988 and 1995. Positron emission tomography was used for preoperative identification of myocardial viability. RESULTS The 30-day mortality was 4.4%. At a median follow-up of 117 months (longest observation, 205 months), the probability of survival at 1, 5, 10, and 15 years after CABG was 93.3%, 84%, 65%, and 44%, respectively. At multivariable analysis, a left ventricular end-diastolic pressure (LVEDP) of 25 mm Hg or more predicted a threefold increase of the hazard of death (p = 0.02), whereas a LVEDP of 20 mm Hg or more correlated with the requirement of an intraaortic balloon pump perioperatively (p = 0.04). Other independent predictors of survival were age older than 70 years and peripheral vascular disease. Cardiac events accounted for 88% of late deaths, which were primarily related to sudden death or progressive heart failure. Most patients were in New York Heart Association functional class I to II at late follow-up. CONCLUSIONS CABG alone yields good long-term outcome in selected angina-free patients with ischemic systolic dysfunction and advanced heart failure. However, associated diastolic impairment, reflected by elevated LVEDP, predicts reduced long-term survival despite myocardial viability.
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MESH Headings
- Age Factors
- Aged
- Blood Pressure
- Cardiac Output, Low/complications
- Cardiac Output, Low/etiology
- Cardiac Output, Low/physiopathology
- Cardiac Output, Low/surgery
- Coronary Artery Bypass
- Death, Sudden, Cardiac/epidemiology
- Disease Progression
- Female
- Follow-Up Studies
- Humans
- Incidence
- Intra-Aortic Balloon Pumping
- Male
- Middle Aged
- Myocardial Ischemia/complications
- Peripheral Vascular Diseases/complications
- Predictive Value of Tests
- Retrospective Studies
- Survival Analysis
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/surgery
- Ventricular Function, Left
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Affiliation(s)
- Marco Pocar
- Università degli Studi di Milano, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy.
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Surgical Treatment of Heart Failure. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50022-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Tulner SAF, Bax JJ, Bleeker GB, Steendijk P, Klautz RJM, Holman ER, Schalij MJ, Dion RAE, van der Wall EE. Beneficial Hemodynamic and Clinical Effects of Surgical Ventricular Restoration in Patients With Ischemic Dilated Cardiomyopathy. Ann Thorac Surg 2006; 82:1721-7. [PMID: 17062236 DOI: 10.1016/j.athoracsur.2006.05.050] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2005] [Revised: 05/10/2006] [Accepted: 05/11/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Surgical ventricular restoration is increasingly applied in patients with ischemic dilated cardiomyopathy. Previous studies show promising results with regard to survival and clinical outcome. However, a comprehensive midterm analysis of this approach on left ventricular (LV) and right ventricular function is not yet available. We investigated biventricular function and clinical status at 6-month follow-up. METHODS We investigated the effects of surgical ventricular restoration on clinical variables, LV volume, right ventricular reverse remodeling, LV dyssynchrony, tricuspid regurgitation, and pulmonary artery pressure in 21 patients with ischemic dilated cardiomyopathy (New York Heart Association class III or IV) who underwent surgical ventricular restoration and coronary artery bypass grafting. Additional surgery included mitral annuloplasty (n = 14) and tricuspid valve annuloplasty (n = 8). Clinical variables (New York Heart Association class, quality-of-life questionnaire, 6-minute hall-walk test) and echocardiographic variables were assessed at baseline and at 6 months. RESULTS At 6-month follow-up, all clinical variables were significantly improved. Left ventricular ejection fraction improved from 0.27 +/- 0.10 to 0.36 +/- 0.11 (p < 0.01), LV end-diastolic volume decreased from 248 +/- 78 mL to 152 +/- 50 mL (p < 0.001), and LV end-systolic volume decreased from 186 +/- 77 mL to 101 +/- 50 mL (p < 0.001). Left ventricular dyssynchrony decreased from 61 +/- 41 ms to 12 +/- 12 ms (p < 0.001). Right ventricular annular diameter decreased from 30 +/- 7 mm to 27 +/- 6 mm, right ventricular short-axis from 30 +/- 9 mm to 27 +/- 7 mm, and right ventricular long-axis from 90 +/- 7 mm to 79 +/- 10 mm (all p < 0.05). Finally, significant reductions in severity of tricuspid regurgitation (from 1.3 +/- 1.1 to 0.9 +/- 0.6; p = 0.001) and pulmonary artery pressure (42 +/- 11 mm Hg to 28 +/- 10 mm Hg; p = 0.015) were observed. CONCLUSIONS Surgical ventricular restoration resulted in improvement of clinical variables, significant LV volume reduction, and reduced LV dyssynchrony at 6-month follow-up. In addition, right ventricular reverse remodeling was noted with reductions in tricuspid regurgitation and pulmonary artery pressure.
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Affiliation(s)
- Sven A F Tulner
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Selzman CH, Bhati RS, Sheridan BC, Stansfield WE, Mill MR. Surgical Therapy for Heart Failure. J Am Coll Surg 2006; 203:226-39; quiz A59-60. [PMID: 16864035 DOI: 10.1016/j.jamcollsurg.2006.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Revised: 04/20/2006] [Accepted: 04/24/2006] [Indexed: 01/14/2023]
Affiliation(s)
- Craig H Selzman
- Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC 27599, USA.
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Racine N, Rouleau JL. The heart failure challenge: optimizing medical and surgical management. Can J Cardiol 2006; 22 Suppl C:8C-12C. [PMID: 16929385 PMCID: PMC2793884 DOI: 10.1016/s0828-282x(06)70996-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Accepted: 05/23/2006] [Indexed: 01/02/2023] Open
Abstract
The treatment of patients with coronary artery disease and left ventricular dysfunction has improved markedly over the past two decades. Nevertheless, the morbidity and mortality rates remain high in this population. In addition to pharmacological therapies to attenuate neurohumoral overactivation, the present challenge is to find additional therapeutic avenues. Percutaneous coronary intervention, although widely used in patients with coronary artery disease, is more challenging with multivessel disease and associated left ventricular dysfunction, and its optimal use in heart failure remains in question. Cardiac surgical revascularization and surgical ventricular restoration have also been advocated. To date, there are no prospective, randomized clinical studies to prove a benefit from these invasive interventions and to identify which patients may derive the most benefit compared with optimal medical therapy alone. The current management of patients with ischemic heart failure needs to be challenged and requires an objective evaluation of these invasive interventions. The ongoing Surgical Treatment for Ischemic Heart Failure (STICH) trial is the first randomized trial designed to determine the long-term benefits of surgical revascularization and surgical ventricular restoration compared with optimal medical therapy alone. The results of this study will provide additional evidence-based information to guide physicians in the rational allocation of health care resources. The role of percutaneous angioplasty in patients with ischemic heart failure also needs to be addressed objectively.
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Affiliation(s)
- Normand Racine
- Department of Medicine, Universit of Montreal and Research Centre, Montreal Heart Institute, Montreal, Quebec.
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Sartipy U, Kjellman U, Samuelsson S, Hagerman I, Wikström G, Larsson T, Albåge A, Lindblom D. Left ventricular reconstruction as an alternative to heart transplantation: a case report. Heart Surg Forum 2006; 9:E638-40. [PMID: 16687346 DOI: 10.1532/hsf98.2006-1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 57-year-old man with dilated cardiomyopathy was referred to our institution to be assessed for heart transplantation. He had symptoms of severe heart failure and left ventricular dysfunction. We proposed surgical ventricular restoration (the Dor procedure) as an alternative to heart transplantation. The patient underwent successful surgery and an uneventful postoperative course. Pre- and postoperative investigations are presented. One year after surgery, the patient is in good clinical and functional condition. This case illustrates that surgical ventricular restoration can be an alternative to heart transplantation.
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Affiliation(s)
- Ulrik Sartipy
- Departments of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
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Aguiar Ribeiro GC, Antoniali F, Lopes MM, Costa CE, Albuquerque AN, Franchini KG. Left Ventricular Reconstruction Brings Benefit for Patients With Ischemic Cardiomyopathy. J Card Fail 2006; 12:189-94. [PMID: 16624683 DOI: 10.1016/j.cardfail.2005.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Revised: 11/03/2005] [Accepted: 11/03/2005] [Indexed: 11/27/2022]
Abstract
BACKGROUND Optimal treatment strategies for some patients with ischemic cardiomyopathy can be unclear. We compared the outcome for patients treated with revascularization only or with additional ventricular reconstruction. METHODS AND RESULTS We compared 74 consecutive patients with an ejection fraction <35% and a left end-systolic volume index >80 mL/m(2). All patients underwent revasularization but some received only revascularization (group 1) and some were randomized into a group that received additional ventricular reconstruction (group 2). Preoperative and postoperative ejection fraction, end-systolic volume, mitral regurgitation, mortality, heart failure (HF) symptoms, and recurrence were compared between groups. There was 1 postoperative death in group 2 (P =. 58). Preoperative ejection fraction between the groups was similar (P =. 19) but it differed significantly postoperatively (P < .001). HF class (New York Heart Association) decreased more in group 2 (group 2, 2.3 +/- 0.4 versus group 1, 1.4 +/- 0.4; P < .001). Incidence of HF recurrence and rehospitalization was significantly less in group 2 (P = .028). The postoperative development of higher-grade mitral regurgitation was greater in group 1 (147 +/- 32 mL/m(2) versus 119 +/- 25 mL/m(2), P = .024). CONCLUSION The outcome at midterm of coronary artery surgery alone in patients with a preoperative large left ventricle was inferior compared with the outcome achieved with additional ventricular restoration.
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Isomura T, Horii T, Suma H, Buckberg GD. Septal anterior ventricular exclusion operation (Pacopexy) for ischemic dilated cardiomyopathy: treat form not disease. Eur J Cardiothorac Surg 2006; 29 Suppl 1:S245-50. [PMID: 16567109 DOI: 10.1016/j.ejcts.2006.03.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 02/28/2006] [Accepted: 03/01/2006] [Indexed: 11/24/2022] Open
Abstract
Objective: Restoration of left ventricle size and shape is an effective surgical procedure in patients with dilated cardiomyopathy. This report defines early and intermediate results following the reshaping of the left ventricle from spherical to ellipsoid configuration in patients with ischemic cardiomyopathy, employing a technique for LV restoration (LVR) that uses form rather than disease as the endpoint for oblique patch placement. Methods: Between 1998 and 2004, a cohort of 83 patients with dilated ischemic cardiomyopathy underwent an operation to reshape the left ventricle. In 54 patients the Dor procedure was done, and 29 underwent the septal anterior ventricular exclusion (SAVE) procedure to emphasize the elliptical shape, whereby patch placement followed an oblique trajectory between the LV apex and septum below the aortic valve. Ventricular form, rather than the disease scar marked the suture placement site endpoint to create an ellipse. The mean age was 58 ± 27, but SAVE patients had larger end systolic volume index (135 ± 38 vs 95 ± 25*). Overall preoperative NYHA functional class III was in 69% and IV in 31 patients, but more SAVE patients were in class IV (38% vs 28%*). The procedures were elective in 72 and emergent in 11, with similar entry criteria for each procedure. Results: In combination with LVR operation, mitral surgery was performed in 49/83 and tricuspid annuloplasty in 23/83 patients, but these procedures were more common after SAVE (59% vs 44%* and 45% vs 19%*, respectively), because of larger LV volumes in SAVE patients; 2.8 ± 1.3 coronary artery bypass grafts were used. Perioperative use of IABP or LVAD was 15 and 1, respectively in 83 patients. Hospital death was in 1/11 or 9% after emergent operations and 3/72 or 4% in elective procedures, with no difference between groups. After discharge from the hospital, NYHA class improved to class I or II in 57 patients, class III/IV in 14 patients, with 10 late deaths. The 5-year survival rate after the elective operation was 80.3% in SAVE and with elective operation and 77.4% in the Dor procedure. Conclusion: The SAVE or Pacopexy technique is easy to reshape the dilated left ventricle from spherical to ellipsoid form after the LVR, and the resultant improved configuration may contribute to the overall results for patients with ischemic dilated cardiomyopathy.
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Affiliation(s)
- Tadashi Isomura
- Hayama Heart Center, 1898 Shimoyamaguchi, Hayama, Kanagawa 240-0116, Japan.
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