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Chouairi F, Levin A, Biegus J, Fudim M. Emerging devices for heart failure management. Prog Cardiovasc Dis 2024; 82:125-134. [PMID: 38242194 DOI: 10.1016/j.pcad.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/14/2024] [Indexed: 01/21/2024]
Abstract
There have been significant advances in the treatment of heart failure (HF) in recent years, driven by significant strides in guideline-directed medical therapy (GDMT). Despite this, HF is still associated with high levels of morbidity and mortality, and most patients do not receive optimal medical therapy. In conjunction with the improvement of GDMT, novel device therapies have been developed to better treat HF. These devices include technology capable of remotely monitoring HF physiology, devices that modulate the autonomic nervous system, and those that structurally change the heart with the ultimate aim of addressing the root causes of HF physiology As these device therapies gradually integrate into the fabric of HF patient care, it becomes increasingly important for modern cardiologists to become familiar with them. Hence, the objective of this review is to shed light on currently emerging devices for the treatment of HF.
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Affiliation(s)
- Fouad Chouairi
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Allison Levin
- Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jan Biegus
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Marat Fudim
- Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine, Durham, NC, USA; Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland; Duke Clinical Research Institute, Durham, NC, USA.
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Yan J, Ai C, Chen Q, Wang Q, Zhu Y, Li M, Chen K, He M, Shen M, Chen L, Zhang R, Zheng C, Liao W, Bin J, Lin H, Ma S, Tan N, Liao Y. CircMap4k2 Reactivated by Aneurysm Plication Alleviates Residual Cardiac Remodeling After SVR by Enhancing Cardiomyocyte Proliferation in Post-MI Mice. J Adv Res 2023:S2090-1232(23)00373-9. [PMID: 38043608 DOI: 10.1016/j.jare.2023.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/05/2023] Open
Abstract
INTRODUCTION Surgical ventricular reconstruction (SVR) is an alternative therapeutic approach in patients with refractory heart failure (HF), but residual remodeling after SVR limits the improvement of HF. Recently, we reported that SVR may act as an environmental cue to reactivate endogenous proliferation of cardiomyocytes; however, it is unclear whether enhancing endogenous cardiomyocyte regeneration further improves HF after SVR. OBJECTIVES We aimed to explore whether circular RNAs (circRNAs) would involved in SVR and their mechanisms. METHODS Male C57BL/6 mice were subjected to myocardial infarction (MI) or sham surgery. Four weeks later, MI mice with a large ventricular aneurysm underwent SVR or a second open-chest operation only. Echocardiography and histological analysis were used to evaluate heart function, cardiac remodeling, and myocardial regeneration. Sequencing of circular RNAs, RNA immunoprecipitation, RNA pulldown, and luciferase reporter assay were used to explore the underlying mechanisms. RESULTS SVR markedly attenuated cardiac remodeling and induced cardiomyocyte regeneration, as evidenced by positive staining of Ki-67, phospho-histone H3 (pH3), and Aurora B in the plication zone, but significant residual remodeling still existed in comparison with the sham group. Sequencing results showed that SVR altered the expression profile of cardiac circRNAs, and circMap4k2 was identified as the most upregulated one. After characterizing circMap4k2, we noted that overexpression of circMap4k2 significantly promoted proliferation of cardiomyocytes in cultured neonatal rat cardiomyocytes and silencing of circMap4k2 significantly inhibited it; similar results were obtained in SVR-treated MI mice but not in MI mice without SVR treatment. Residual cardiac remodeling after SVR was further attenuated by circMap4k2 overexpression. CircMap4k2 bound with miR-106a-3p and inhibited cardiomyocyte proliferation by targeting a downstream effector of the antizyme inhibitor 1 (Azin1) gene. CONCLUSIONS CircMap4k2 acts as an environmental cue and targets the miR-106a-3p/Azin1 pathway to increase cardiac regeneration in the plication zone and attenuate residual remodeling after SVR.
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Affiliation(s)
- Junyu Yan
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chenzhi Ai
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qi Chen
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qiuhan Wang
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yingqi Zhu
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mingjue Li
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kaitong Chen
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mingyuan He
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mengjia Shen
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lu Chen
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rui Zhang
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Cankun Zheng
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wangjun Liao
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianping Bin
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hairuo Lin
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Siyuan Ma
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ning Tan
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
| | - Yulin Liao
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China; Cardiovascular Center, the Affiliated Sixth Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
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Cho Y, Ueda T, Kotani S, Okada K, Ozawa K, Shimura S, Shimizu H. AATS 2023: Left ventricular restoration with scar exclusion in the surgical treatment for ischemic heart failure. Int J Cardiol 2023; 391:131277. [PMID: 37598910 DOI: 10.1016/j.ijcard.2023.131277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/04/2023] [Accepted: 08/17/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE Post-infarction myocardial scar as detected by cardiac magnetic resonance (CMR) is associated with adverse left ventricular (LV) remodeling and negatively affects the prognosis. We sought to analyze the impact of left ventricular restoration (LVR) with asynergic scar exclusion on long-term outcomes for patients with ischemic heart failure (IHF). METHODS From January 2005, 134 consecutive patients with IHF underwent scar-exclusive LVR. Among the 131 survivors, 108 patients had paired late gadolinium enhancement (LGE)-CMR preoperatively and one year after, and represent the study population. Patients were divided into two groups according to whether their post-LVR residual percentage of scarred LV perimeter was <35% (%Scar <35; n = 55) or more (%Scar ≥35; n = 53). We compared the two groups, by looking at LGE-CMR outcomes, and at long-term survival and cardiac event (hospitalization for cardiac causes)-free survival. RESULTS Postoperative LV end-systolic volume index decreased significantly and ejection fraction increased with significant increase in stroke volume index (P < 0.05 for both). LV diastolic function of the left atrial volume index was significantly improved in patients with residual %Scar <35 than in those with %Scar ≥35 (P interaction = 0.005). Median survival in patients with residual %Scar <35 and ≥ 35 were 8.3 (4.5-12.2) years and 6.8 (1.8-11.8) years respectively (P = 0.106). Median cardiac event-free survival in patients with %Scar <35 and ≥ 35 were 8.0 (3.9-12.1) years and 4.8 (0.8-8.8) years respectively (P < 0.001). CONCLUSIONS Scar-exclusive LVR yielded sustainable improvement in LV function and favorable long-term survival regardless of the extent of residual scar. The LVR should be performed to attain scar exclusion in the surgical treatment for IHF, which in turn might protectively affect LV diastolic function and cardiac event-free survival.
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Affiliation(s)
- Yasunori Cho
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan.
| | - Thoshihiko Ueda
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Sohsyu Kotani
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan.
| | - Kimiaki Okada
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan.
| | - Keisuke Ozawa
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Shinichiro Shimura
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan.
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University, Tokyo, Japan
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Filippini FB, Ribeiro HB, Bocchi E, Bacal F, Marcondes-Braga FG, Avila MS, Sturmer JD, Marchi MFDS, Kanhouche G, Freire AF, Cassar R, Abizaid AA, de Brito FS. Percutaneous Strategies in Structural Heart Diseases: Focus on Chronic Heart Failure. Arq Bras Cardiol 2023; 120:e20220496. [PMID: 38126512 PMCID: PMC10773459 DOI: 10.36660/abc.20220496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 04/05/2023] [Accepted: 05/17/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Central Illustration : Percutaneous Strategies in Structural Heart Diseases: Focus on Chronic Heart Failure Transcatheter devices for monitoring and treating advanced chronic heart failure patients. PA: pulmonary artery; LA: left atrium; AFR: atrial flow regulator; TASS: Transcatheter Atrial Shunt System; VNS: vagus nerve stimulation; BAT: baroreceptor activation therapy; RDN: renal sympathetic denervation; F: approval by the American regulatory agency (FDA); E: approval by the European regulatory agency (CE Mark). BACKGROUND Innovations in devices during the last decade contributed to enhanced diagnosis and treatment of patients with cardiac insufficiency. These tools progressively adapted to minimally invasive strategies with rapid, widespread use. The present article focuses on actual and future directions of device-related diagnosis and treatment of chronic heart failure.
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Affiliation(s)
- Filippe Barcellos Filippini
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Alemão Oswaldo CruzSão PauloSPBrasil Hospital Alemão Oswaldo Cruz , São Paulo , SP – Brasil
| | - Henrique Barbosa Ribeiro
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Edimar Bocchi
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Fernando Bacal
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Fabiana G. Marcondes-Braga
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Monica S. Avila
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Janine Daiana Sturmer
- Hospital Alemão Oswaldo CruzSão PauloSPBrasil Hospital Alemão Oswaldo Cruz , São Paulo , SP – Brasil
| | - Mauricio Felippi de Sá Marchi
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Gabriel Kanhouche
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
| | - Antônio Fernando Freire
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Renata Cassar
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Alexandre A. Abizaid
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
| | - Fábio Sândoli de Brito
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP – Brasil
- Hospital Sírio-LibanêsSão PauloSPBrasil Hospital Sírio-Libanês , São Paulo , SP – Brasil
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Liu Y, Cai Z, Xu L, Zheng Y, Chen M, Dong N, Chen S. Concomitant valve surgery is associated with worse outcomes in surgical treatments of post-infarction ventricular aneurysm. Front Cardiovasc Med 2023; 10:1194374. [PMID: 37655215 PMCID: PMC10465797 DOI: 10.3389/fcvm.2023.1194374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023] Open
Abstract
Objective To evaluate the impact of concomitant valve surgery on the prognosis of patients who experienced coronary artery bypass graft (CABG) with/without ventricular reconstruction for the ventricular aneurysm. Methods In our department, 354 patients underwent CABG with/without ventricular reconstruction for a ventricular aneurysm from July 23rd, 2000 to December 23rd, 2022. A total of 77 patients received concomitant valve surgery, 37 of whom underwent replacement, and 40 of whom underwent repair. The baseline characteristics, prognostic, and follow-up information were statically analyzed. Univariate and multivariate Cox regression analyses were applied to identify the risk factors of long-term outcomes. Results Compared with patients who did not undergo valvular surgery, patients who experienced concomitant valve surgical treatments had a significantly lower survival rate (p = 0.00022) and a longer total mechanical ventilation time. Subgroup analysis indicated that the options of repair or replacement exhibited no statistically significant difference in postoperative mortality (p = 0.44) and prognosis. The multivariate Cox regression analysis suggested that the pre-operative cholesterol level (HR = 1.68), postoperative IABP (HR = 6.29), NYHA level (HR = 2.84), and pre-operative triglyceride level (HR = 1.09) were independent and significant predictors for overall all-cause mortality after surgery. Conclusion Concomitant valve surgery was considerably related to a higher risk of postoperative mortality in patients with post-infarction ventricle aneurysms who underwent surgical treatments. No significant difference in the prognosis outcomes was observed between the operating methods of repair or replacement valve surgery.
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Affiliation(s)
| | | | | | | | | | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Si Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Salah HM, Fudim M, Burkhoff D. Device Interventions for Heart Failure. JACC. HEART FAILURE 2023; 11:1039-1054. [PMID: 37611987 DOI: 10.1016/j.jchf.2023.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 08/25/2023]
Abstract
Despite remarkable advances in drug therapy for heart failure (HF), the residual HF-related morbidity, mortality, and hospitalizations remain substantial across all HF phenotypes, and significant proportions of patients with HF remain symptomatic despite optimal drug therapy. Driven by these unmet clinical needs, the exponential growth of transcatheter interventions, and a recent shift in the regulatory landscape of device-based therapies, novel device-based interventions have emerged as a potential therapy for various phenotypes of HF. Device-based interventions can overcome some of the limitations of drug therapy (eg, intolerance, nonadherence, inconsistent delivery, and recurrent and long-term cost) and can target some HF-related pathophysiologic pathways more effectively than drug therapy. This paper reviews the current evolving landscape of device-based interventions in HF and highlights critical points related to implementation of these therapies in the current workflow of HF management.
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Affiliation(s)
- Husam M Salah
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Marat Fudim
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Daniel Burkhoff
- Cardiovascular Research Foundation, New York, New York, USA.
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Hamid N, Jorde UP, Reisman M, Latib A, Lim DS, Joseph SM, Kurlianskaya A, Polonetsky O, Neuzil P, Reddy V, Foerst J, Gada H, Grubb KJ, Silva G, Kereiakes D, Shreenivas S, Pinney S, Davidavicius G, Sorajja P, Boehmer JP, Kleber FX, Perier P, VAN Mieghem NM, Dumonteil N, Leon MB, Burkhoff D. Transcatheter Left Ventricular Restoration in Patients With Heart Failure. J Card Fail 2023; 29:1046-1055. [PMID: 36958391 DOI: 10.1016/j.cardfail.2023.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Left ventricular (LV) volume reshaping reduces myocardial wall stress and may induce reverse remodeling in patients with heart failure with reduced ejection fraction. The AccuCinch Transcatheter Left Ventricular Restoration system consists of a series of anchors connected by a cable implanted along the LV base that is cinched to the basal free wall radius. We evaluated the echocardiographic and clinical outcomes following transcatheter left ventricular restoration. METHODS AND RESULTS We analyzed 51 heart failure patients with a left ventricular ejection fraction between 20% and 40%, with no more than 2+ mitral regurgitation treated with optimal medical therapy, who subsequently underwent transcatheter left ventricular restoration. Serial echocardiograms, Kansas City Cardiomyopathy Questionnaire scores, and 6-minute walk test distances were measured at baseline through 12 months. Primary analysis end point was change in end-diastolic volume at 12 months compared with baseline. Patients (n = 51) were predominantly male (86%) with a mean age of 56.3 ± 13.1 years. Fluoroscopy showed LV free wall radius decreased by a median of 9.2 mm amounting to a 29.6% decrease in the free wall arc length. At 12 months, the LV end-diastolic volume decreased by 33.6 ± 34.8 mL (P < .01), with comparable decreases in the LV end-systolic volume. These decreases were associated with significant improvements in the overall Kansas City Cardiomyopathy Questionnaire score (16.4 ± 18.7 points; P < .01) and 6-minute hall walk test distance (45.9 ± 83.9 m; P < .01). There were no periprocedural deaths; through the 1-year follow-up, 1 patient died (day 280) and 1 patient received a left ventricular assist device (day 13). CONCLUSIONS In patients with heart failure with reduced ejection fraction without significant mitral regurgitation receiving optimal medical therapy, the AccuCinch System resulted in decreases of LV volume, as well as improved quality of life and exercise endurance. A randomized trial is ongoing (NCT04331769).
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Affiliation(s)
- Nadira Hamid
- Columbia University Medical Center/ NY Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Ulrich P Jorde
- Montefiore Medical Center, New York, New York; Albert Einstein College of Medicine, Bronx, New York
| | | | - Azeem Latib
- Montefiore Medical Center, New York, New York; Albert Einstein College of Medicine, Bronx, New York
| | - D Scott Lim
- University of Virginia, Charlottesville, Virginia
| | - Susan M Joseph
- University of Maryland Medical Center, Baltimore, Maryland
| | | | - Oleg Polonetsky
- Republican Scientific and Practical Center Cardiology, Minsk, Belarus
| | | | - Vivek Reddy
- Icahn School of Medicine Mount Sinai, New York, New York
| | - Jason Foerst
- Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Hemal Gada
- UPMC Heart and Vascular Institute, Pinnacle Health, Harrisburg, Pennsylvania
| | | | | | | | | | - Sean Pinney
- University of Chicago, Division of Cardiology, Chicago, Illinois
| | - Giedrius Davidavicius
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, and Cardiology and Angiology Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Paul Sorajja
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | - Franz X Kleber
- Martin Luther Universität Halle-Wittenberg, PGS Wittenberg, Germany
| | - Patrick Perier
- Campus Bad Neustadt, Herzchirurgie, Bad Neustadt/Saale, Germany
| | - Nicolas M VAN Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Martin B Leon
- Columbia University Medical Center/ NY Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
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Spilias N, Howard TM, Anthony CM, Laczay B, Soltesz EG, Starling RC, Sievert H, Estep JD, Kapadia SR, Puri R. Transcatheter left ventriculoplasty. EUROINTERVENTION 2023; 18:1399-1407. [PMID: 37092265 PMCID: PMC10113960 DOI: 10.4244/eij-d-22-00544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/07/2022] [Indexed: 04/25/2023]
Abstract
Despite significant advances in pharmacological, electrophysiological and valve therapies for heart failure with reduced ejection fraction (HFrEF), the associated morbidity, mortality and healthcare costs remain high. With a constantly growing heart failure population, the existing treatment gap between current and advanced heart failure therapies (e.g., left ventricular [LV] assist devices, heart transplantation) reflects a large unmet need, calling for novel therapeutic approaches. Left ventricular remodelling and dilatation, with or without scar formation, is the hallmark of cardiomyopathy and is associated with poor prognosis. In the era of exciting advances in structural heart interventions, the advent of minimally invasive, device-based therapies directly targeting the LV geometry and promoting physical reverse remodelling has created a new frontier in the battle against heart failure. Interventional heart failure therapy is a rapidly emerging field, encompassing structural heart and minimally invasive hybrid procedures, with two left ventriculoplasty devices currently under investigation in pivotal clinical trials in the US. This review addresses the rationale for left ventriculoplasty, presents the prior surgical and percutaneous attempts in the field, provides an overview of the novel transcatheter left ventriculoplasty devices and their respective trials, and highlights potential challenges associated with establishing such device-based therapies in our armamentarium against heart failure.
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Affiliation(s)
- Nikolaos Spilias
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Travis M Howard
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chris M Anthony
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Balint Laczay
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Edward G Soltesz
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- CardioVascular Center Frankfurt, Frankfurt, Germany
| | - Randall C Starling
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jerry D Estep
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir R Kapadia
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rishi Puri
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- CardioVascular Center Frankfurt, Frankfurt, Germany
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Hrycek E, Walawska-Hrycek A, Szymański R, Stoliński J, Nowakowski P, Żurakowski A. Giant left ventricular inferior wall aneurysm as a late complication after myocardial infarction: A case report. Echocardiography 2023; 40:259-265. [PMID: 36597587 DOI: 10.1111/echo.15512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 01/05/2023] Open
Abstract
A case of a 64-year-old patient who was referred to interventional cardiology unit in order to qualify her to mitral valve repair is presented. Transthoracic echocardiography revealed a giant inferior wall basal aneurysm of the left ventricle (44 mm × 31 mm, 57 ml) and coronary angiography revealed chronic total occlusion of the proximal right coronary artery. The patient refused surgical treatment and was treated with pharmacotherapy alone. At 1 year follow-up, clear progression of the disease was observed. Based on this case study, we would cautiously suggest that in similar cases of large inferobasal wall aneurysms causing severe MR, OMT may be insufficient to prevent disease progression, and that early surgical intervention may be preferred.
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Affiliation(s)
- Eugeniusz Hrycek
- American Heart of Poland, Chrzanów, Poland.,Department of Cardiology, Faculty of Medical Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
| | - Anna Walawska-Hrycek
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | | | - Przemysław Nowakowski
- American Heart of Poland, Chrzanów, Poland.,University of Technology, Katowice, Poland
| | - Aleksander Żurakowski
- American Heart of Poland, Chrzanów, Poland.,Department of Cardiology, Faculty of Medical Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
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10
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Ma S, Chen L, Yan J, Shen M, Zhang R, Li M, He M, Chen K, Zhu Y, Lin H, Wang Y, Liao W, Bin J, Zheng C, Liao Y. Dapagliflozin attenuates residual cardiac remodeling after surgical ventricular reconstruction in mice with an enlarged heart after myocardial infarction. Biomed Pharmacother 2022; 156:113765. [PMID: 36228368 DOI: 10.1016/j.biopha.2022.113765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Severe heart failure refractory to conventional therapy requires alternative treatment modalities. Surgical ventricular reconstruction (SVR) has been used to reverse cardiac remodeling in post-myocardial infarction (MI) patients with large left ventricular (LV) aneurysm, however, residual LV remodeling and dysfunction remain postoperatively. It is unclear whether SVR recovers response to drug treatment and whether the sodium-glucose co-transporter 2 inhibitor dapagliflozin (DAPA) reverses residual LV remodeling after SVR. METHODS Adult male C57 mice were subjected to MI or sham surgery. Four-week later, MI mice with LV aneurysm underwent modified SVR or second open-chest sham operation and were randomized to DAPA or vehicle for four-week. Cardiac remodeling, LV function, and the underlying mechanisms were evaluated by echocardiography, invasive LV hemodynamic measurements, mRNA sequencing, and bioinformatics analysis. RESULTS SVR significantly decreased LV volume; increased myocardial strain, LV pressure change rates and end-systolic elastance; and decreased heart-to-body weight ratio and myocardial fibrosis. However, significant residual cardiac remodeling remained. DAPA significantly attenuated residual cardiac remodeling and improved LV function in SVR mice but did not have curative effects in non-SVR mice. Of the 1532 genes differentially expressed in SVR and MI mice, 1037 were associated with cardiac metabolism; Src, Crebbp, Fn1, Grb2, and Mapk14 were the top 5 hub genes. Unlike sham surgery, MI upregulated those 5 genes, and treatment with SVR + DAPA normalized their expression. CONCLUSIONS SVR restores therapeutic response in the post-MI heart with large LV aneurysm, and DAPA attenuates residual cardiac remodeling after SVR by normalizing some cardiac metabolism-related hub genes.
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Affiliation(s)
- Siyuan Ma
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Lu Chen
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Junyu Yan
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Mengjia Shen
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Rui Zhang
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Mingjue Li
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Mingyuan He
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Kaitong Chen
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Yingqi Zhu
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Hairuo Lin
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Yuegang Wang
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Wangjun Liao
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Jianping Bin
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Cankun Zheng
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China.
| | - Yulin Liao
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China.
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11
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Hegeman RR, Swaans MJ, Van Kuijk JP, Klein P. Midterm Outcome of Hybrid Transcatheter and Minimally Invasive Left Ventricular Reconstruction for the Treatment of Ischemic Heart Failure. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100081. [PMID: 37288056 PMCID: PMC10242554 DOI: 10.1016/j.shj.2022.100081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/06/2022] [Accepted: 07/15/2022] [Indexed: 06/09/2023]
Abstract
Background Left ventricular (LV) remodeling after anterior myocardial infarction (AMI) can cause a pathological increase in LV volume, reduction in LV ejection fraction (EF), and symptomatic heart failure (HF). This study evaluates the midterm results of a hybrid transcatheter and minimally invasive surgical technique to reconstruct the negatively remodeled LV by myocardial scar plication and exclusion with microanchoring technology. Methods Retrospective single-center analysis of patients who underwent hybrid LV reconstruction (LVR) with the Revivent TransCatheter System. Patients were accepted for the procedure when they presented with symptomatic HF (New York Heart Association class ≥ II, EF < 40%) after AMI, in the presence of a dilated LV with either akinetic or dyskinetic scar in the anteroseptal wall and/or apex of ≥50% transmurality. Results Between October 2016 and November 2021, 30 consecutive patients were operated. Procedural success was 100%. Comparing echocardiographic data preoperatively and directly postoperatively, LVEF increased from 33 ± 8% to 44 ± 10% (p < 0.0001). LV end-systolic volume index decreased from 58 ± 24 mL/m2 to 34 ± 19 mL/m2 (p < 0.0001) and LV end-diastolic volume index decreased from 84 ± 32 mL/m2 to 58 ± 25 mL/m2 (p < 0.0001). Hospital mortality was 0%. After a mean follow-up of 3.4 ± 1.3 years, there was a significant improvement of New York Heart Association class (p = 0.001) with 76% of surviving patients in class I-II. Conclusions Hybrid LVR for symptomatic HF after AMI is safe and results in significant improvement in EF, reduction in LV volumes, and sustained improvement in symptoms.
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Affiliation(s)
- Romy R.M.J.J. Hegeman
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Martin J. Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jan-Peter Van Kuijk
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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12
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Adhyapak SM. The impact of left ventricular geometry and remodeling on prognosis of heart failure in ischemic cardiomyopathy. J Card Surg 2022; 37:2168-2171. [PMID: 35338516 DOI: 10.1111/jocs.16438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 11/29/2022]
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13
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Nemchyna O, Solowjowa N, Dandel M, Hrytsyna Y, Stein J, Knierim J, Schoenrath F, Hennig F, Falk V, Knosalla C. Predictive Value of Two-Dimensional Speckle-Tracking Echocardiography in Patients Undergoing Surgical Ventricular Restoration. Front Cardiovasc Med 2022; 9:824467. [PMID: 35387444 PMCID: PMC8978793 DOI: 10.3389/fcvm.2022.824467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/31/2022] [Indexed: 01/28/2023] Open
Abstract
Objectives Parameters of left ventricular (LV) mechanics, obtained from speckle-tracking echocardiography (STE), were found to be of prognostic value in patients with heart failure and those who underwent cardiac surgery. This study aimed to assess the value of STE in patients scheduled to undergo surgical ventricular restoration (SVR). Methods A total of 158 consecutive patients with baseline STE who underwent SVR due to an LV anteroapical aneurysm were included in the analysis. Preoperative longitudinal STE parameters were evaluated for their association with an outcome, defined as all-cause mortality, LV assist device implantation, or heart transplantation. The echocardiographic follow-up to assess the change in the regional function of the segments remote from the aneurysm was performed in 43 patients at a median of 10 months [interquartile range (IQR): 6–12.7 months] after SVR. Results During a median follow-up of 5.1 years (IQR: 1.6–8.7 years), events occurred in 68 patients (48%). Less impaired mean basal end-systolic longitudinal strain (BLS) with a cutoff value ≤ −10.1 % demonstrated a strong association with event-free survival, also in patients with an LV shape corresponding to an intermediate shape between aneurysmal and globally akinetic. Initially hypo- or akinetic basal segments with preoperative end-systolic strain ≤ −7.8% showed a greater improvement in wall motion at the short-term follow up. Conclusion Patients with less impaired preoperative BLS exhibited a better event-free survival after SVR, also those with severe LV remodeling. The preserved preoperative segmental longitudinal strain was associated with a greater improvement in regional wall motion after SVR. BLS assessment may play a predictive role in patients with an LV anteroapical aneurysm who are scheduled to undergo SVR.
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Affiliation(s)
- Olena Nemchyna
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Natalia Solowjowa
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | | | - Yuriy Hrytsyna
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Julia Stein
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Jan Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Felix Hennig
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- ETH Zurich, Department of Health Sciences and Technology, Translational Cardiovascular Technology, Zurich, Switzerland
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- *Correspondence: Christoph Knosalla
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14
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Hieda T, Shingu Y, Sugimoto S, Asai H, Yamakawa T, Wakasa S. Effects of trehalose on recurrence of remodeling after ventricular reconstruction in rats with ischemic cardiomyopathy. Heart Vessels 2022; 37:528-537. [PMID: 35013770 DOI: 10.1007/s00380-021-01990-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/12/2021] [Indexed: 12/09/2022]
Abstract
Recurrence of left ventricular (LV) remodeling after surgical ventricular reconstruction (SVR) for ischemic cardiomyopathy has been reported to be partially attributed to autophagy. We aimed to examine the effects of trehalose, an autophagy inducer, on the recurrence of LV remodeling after SVR. After SVR in rats with ICM, trehalose was orally administered. The changes in LV end-diastolic dimension (LVEDD) and fractional shortening (FS) were evaluated. The activation of myocardial autophagy was also estimated by autophagy markers: microtubule-associated light chain 3 II (LC3-II) and p62; the former usually increases and the latter decreases if autophagy is activated. Significant LV reverse remodeling was observed early after SVR. On the other hand, the 28th postoperative day SVR + trehalose was associated with smaller LVEDD and better FS than SVR alone (LVEDD, P = 0.043; FS, P < 0.01). LC3-II increased comparably in both groups, while p62 was significantly lower in the SVR + trehalose group than in the SVR alone group (P < 0.01). In conclusion, trehalose attenuated the recurrence of LV remodeling and changed autophagy markers after SVR in rats with ICM. Trehalose may be a candidate for adjuvant therapy to retain the effects of SVR.
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Affiliation(s)
- Tetsuya Hieda
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido University, Kita 15, Nishi 7, Kitaku, Sapporo, 060-8638, Japan
| | - Yasushige Shingu
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido University, Kita 15, Nishi 7, Kitaku, Sapporo, 060-8638, Japan.
| | - Satoshi Sugimoto
- Department of Cardiovascular Surgery, Obihiro Kosei Hospital, Obihiro, Japan
| | - Hidetsugu Asai
- Department of Cardiovascular Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Tomoji Yamakawa
- Department of Cardiovascular Surgery, Kinikyo Chuo Hospital, Sapporo, Japan
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido University, Kita 15, Nishi 7, Kitaku, Sapporo, 060-8638, Japan
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15
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Ma S, Yan J, Yang D, Liao W, Bin J, Lin H, Liao Y. A Modified Surgical Ventricular Reconstruction in Post-infarction Mice Persistently Alleviates Heart Failure and Improves Cardiac Regeneration. Front Cardiovasc Med 2022; 8:789493. [PMID: 35004900 PMCID: PMC8740235 DOI: 10.3389/fcvm.2021.789493] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/08/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives: Large ventricular aneurysm secondary to myocardial infarction (MI) results in severe heart failure (HF) and limits the effectiveness of regeneration therapy, which can be improved by surgical ventricular reconstruction (SVR). However, the conventional SVR procedures do not yield optimal long-term outcome in post-MI rodents. We hypothesized that a modified SVR procedure without aggressive purse string suture would persistently alleviate HF and improve cardiac regeneration in post-MI mice. Methods: Adult male C57 mice were subjected to MI or sham surgery. Four weeks later, mice with MI underwent SVR or 2nd open-chest operation alone. SVR was performed by plicating the aneurysm with a single diagonal linear suture from the upper left ventricle (LV) to the right side of the apex. Cardiac remodeling, heart function and myocardial regeneration were evaluated. Results: Three weeks after SVR, the scar area, LV volume, and heart weight/body weight ratio were significantly smaller, while LV ejection fraction, the maximum rising and descending rates of LV pressure, LV contractility and global myocardial strain were significantly higher in SVR group than in SVR-control group. The inhibitory effects of SVR on LV remodeling and HF persisted for at least eight-week. SVR group exhibited improved cardiac regeneration, as reflected by more Ki67-, Aurora B- and PH3-positive cardiomyocytes and a higher vessel density around the plication area of the infarcted LV. Conclusions: SVR with a single linear suture results in a significant and sustained reduction in LV volume and improvement in both LV systolic and diastolic function as well as cardiac regeneration.
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Affiliation(s)
- Siyuan Ma
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, National Clinical Research Center of Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Junyu Yan
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, National Clinical Research Center of Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Dexuan Yang
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, National Clinical Research Center of Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wangjun Liao
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianping Bin
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, National Clinical Research Center of Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hairuo Lin
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, National Clinical Research Center of Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yulin Liao
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, National Clinical Research Center of Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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16
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Fatehi Hassanabad A, Wiebe K, Ali IS. Clinical and hemodynamic outcomes of the Dor procedure in adults with ischemic cardiomyopathy. J Card Surg 2021; 36:4345-4366. [PMID: 34494297 DOI: 10.1111/jocs.15968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/07/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022]
Abstract
Ischemic cardiomyopathy continues to be a major contributor to congestive heart failure, which places a significant burden on our healthcare system. Improving medications and different coronary revascularization strategies are the mainstays in the management of ischemic cardiomyopathy. Although medications and mechanical circulatory support are playing an ever-increasing role, cardiac transplantation remains the gold standard for treating advanced heart failure. Given the small number of available and suitable donor hearts, transplantation is limited for the majority of patients. Surgical ventricular restoration has repeatedly been suggested as a viable alternative in managing heart failure in select patients, as it is believed that surgically returning the ventricle to its original dimensions is possible and associated with favorable outcomes. The purpose of this manuscript is to comprehensively review the current literature on various surgical strategies for ventricular restoration. We also contextualize the published data with respect to ventricular function, volume, structure, arrhythmias, mitral regurgitation, and clinical outcomes.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kiana Wiebe
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Imtiaz S Ali
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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17
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Adhyapak SM, Parachuri VR, Thomas T, Varghese K. Left ventricular function and survival in ischemic cardiomyopathy: Implications for surgical ventricular restoration. JTCVS OPEN 2021; 7:211-218. [PMID: 36003693 PMCID: PMC9390468 DOI: 10.1016/j.xjon.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 12/04/2022]
Abstract
Objectives This pilot study evaluates the association of relative wall thickness (RWT) on survival in patients with ischemic cardiomyopathy (ICM). We hypothesized that patients with preserved RWT may be better candidates for surgical ventricular restoration than those with thinner RWT. Methods Echocardiography was performed in 165 consecutive patients (aged 58.2 ± 14.7 years) divided into 2 groups based on RWT values. Group 1 had patients with preserved RWT and group 2 had patients with reduced RWT. Results There were 120 (72.7%) patients with hypertension and 112 (67.8%) patients had diabetes mellitus. The patients with preserved RWT (group 1) had significantly more hypertension and diabetes. The patients with decreased RWT (group 2) were in a higher New York Heart Association functional class and had significantly greater incidence of anterior wall myocardial infarction. The entire cohort was followed over 24 months (group 1: n = 117 and group 2: n = 48). The overall all-cause mortality in group 1 (preserved RWT) was 7 (5.9%) and in group 2 (reduced RWT) was 35 (72.9%) (P < .0001). When readmission for congestive heart failure was analyzed, group 2 patients with lower RWT (P < .0001) had an increased rate of readmissions for heart failure. Conclusions In patients with ischemic cardiomyopathy, a lower RWT indicative of dilated LV remodeling was associated with increased mortality and readmission for heart failure. The RWT may be a simple benchmark of viable or contractile myocardium in ICM. It can be hypothesized that patients with preserved RWT may benefit from surgical ventricular restoration.
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18
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Fudim M, Abraham WT, von Bardeleben RS, Lindenfeld J, Ponikowski PP, Salah HM, Khan MS, Sievert H, Stone GW, Anker SD, Butler J. Device Therapy in Chronic Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:931-956. [PMID: 34446165 PMCID: PMC9941752 DOI: 10.1016/j.jacc.2021.06.040] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022]
Abstract
The regulatory landscape for device-based heart failure (HF) therapies has seen a major shift in the last 7 years. In 2013, the U.S. Food and Drug Administration released guidance for early feasibility and first-in-human studies, thereby encouraging device innovation, and in 2016 the U.S. Congress authorized the Breakthrough Devices Program to expedite access for Americans to innovative devices indicated for diagnosis and treatment of serious illnesses, such as HF. Since December 2016, there has been an increase in the number of HF devices for which manufacturers are seeking approval through the breakthrough designation pathway. This has led to a rapid uptake in the development and evaluation of device-based HF therapies. This article reviews the current and future landscape of device therapies for chronic HF and associated comorbidities and the regulatory environment that is driving current and future innovation.
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Affiliation(s)
- Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
| | - William T. Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Ralph Stephan von Bardeleben
- Medizinische Klinik - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsmedizin Mainz, Mainz, Germany
| | - JoAnn Lindenfeld
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Piotr P. Ponikowski
- Centre for Heart Diseases, University Hospital, Wroclaw, Poland,Department of Heart Diseases, Medical University, Wroclaw, Poland
| | - Husam M. Salah
- Department of Medicine, University of Arkansas for Medical Sciences, AR, USA
| | - Muhammad Shahzeb Khan
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
| | - Horst Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany,Anglia Ruskin University, Chelmsford, United Kingdom
| | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, and the Cardiovascular Research Foundation, New York, NY, USA
| | - Stefan D. Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, Mississippi, USA.
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Long-Term Results of Hybrid Left Ventricular Reconstruction in the Treatment of Ischemic Cardiomyopathy. J Cardiovasc Transl Res 2021; 14:1043-1050. [PMID: 33974231 PMCID: PMC8651588 DOI: 10.1007/s12265-021-10133-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/26/2021] [Indexed: 12/03/2022]
Abstract
The evidence supporting surgical aneurysmectomy in ischemic heart failure is inconsistent. The aim of the study was to describe long-term effect of minimally invasive hybrid transcatheter and minithoracotomy left ventricular (LV) reconstruction in patients with ischemic cardiomyopathy. Twenty-three subjects with transmural anterior wall scarring, LV ejection fraction 15–45%, and New York Heart Association class ≥ II were intervened using Revivent TC anchoring system. LV end-systolic volume index was reduced from 73.2 ± 27 ml at baseline to 51.5 ± 22 ml after 6 months (p < 0.001), 49.9 ± 20 ml after 2 years (p < 0.001), and 56.1 ± 16 ml after 5 years (p = 0.047). NYHA class improved significantly at 5 years compared to baseline. Six-min walk test distance increased at 2 years compared to the 6-month visit. Hybrid LV reconstruction using the anchoring system provides significant and durable LV volume reduction during 5-year follow-up in preselected patients with ischemic heart failure.
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20
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Bakaeen FG, Gaudino M, Whitman G, Doenst T, Ruel M, Taggart DP, Stulak JM, Benedetto U, Anyanwu A, Chikwe J, Bozkurt B, Puskas JD, Silvestry SC, Velazquez E, Slaughter MS, McCarthy PM, Soltesz EG, Moon MR. 2021: The American Association for Thoracic Surgery Expert Consensus Document: Coronary artery bypass grafting in patients with ischemic cardiomyopathy and heart failure. J Thorac Cardiovasc Surg 2021; 162:829-850.e1. [PMID: 34272070 DOI: 10.1016/j.jtcvs.2021.04.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Faisal G Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Coronary Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Glenn Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Md
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David P Taggart
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - John M Stulak
- Division of Cardiothoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
| | - Umberto Benedetto
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Anelechi Anyanwu
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute at Cedars-Sinai, Los Angeles, Calif
| | - Biykem Bozkurt
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Tex
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside Hospital, New York, NY
| | | | - Eric Velazquez
- Department of Cardiovascular Medicine, Heart and Vascular Center, Yale New Haven Health, New Haven, Conn
| | - Mark S Slaughter
- Department Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Ky
| | - Patrick M McCarthy
- Bluhm Cardiovascular Institute and Division of Cardiac Surgery in the Department of Surgery, Northwestern University, Chicago, Ill
| | - Edward G Soltesz
- Department of Thoracic and Cardiovascular Surgery, Coronary Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo
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21
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Ahmed R, Botezatu B, Nanthakumar M, Kaloti T, Harky A. Surgery for heart failure: Treatment options and implications. J Card Surg 2021; 36:1511-1519. [PMID: 33527493 DOI: 10.1111/jocs.15384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/02/2021] [Accepted: 01/21/2021] [Indexed: 02/06/2023]
Abstract
Heart failure is considered one of the leading causes of death worldwide. Over the years, etiological risk factors, diagnostic criteria, and classifications have been revised to create guide management needed to alleviate the global health burden caused by heart failure. Pharmacological treatments have progressed over time but are insufficient in reducing mortality. This leads to many patients developing advanced heart failure who will require surgical intervention often in the form of the gold standard, a heart transplant. However, the number of patients requiring a transplant far exceeds the number of donors. Other surgical inventions have been utilized, yet the rate of patients being diagnosed with heart failure is still increasing. Future developments in the surgical field of heart failure include the 77SyncCardia and atrial shunting but long-term clinical trials involving larger cohorts of patients have not yet taken place to view how effective these approaches can be.
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Affiliation(s)
- Rukhsana Ahmed
- Medical School, St George's, University of London, Cranmer Terrace, UK
| | - Bianca Botezatu
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | - Tamara Kaloti
- Department of Epidemiology and Healthcare, University College London, London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Cardiac surgery, Alder Hey NHS Foundation Trust, Liverpool, UK
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22
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Szlapka M, Hetzer R, Ennker J, Hausmann H. Conventional cardiac surgery in patients with end-stage coronary artery disease: yesterday and today. Cardiovasc Diagn Ther 2021; 11:202-212. [PMID: 33708493 DOI: 10.21037/cdt-20-284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Surgical therapy of combined coronary artery disease (CAD) and heart failure, also referred to as end-stage CAD, has evolved throughout the years and patients are currently being offered traditional coronary artery bypass grafting (CABG), with or without surgical ventricle restoration (SVR), interventions for ischemic mitral valve regurgitation, heart transplantation or implantation of mechanical cardiovascular support systems. Among surgical methods, operative myocardial revascularization (with or without ventricle restoration) is still playing an important role, aiming at restoration of proper myocardial perfusion, especially if heart muscle viability is present. Facing the donor shortage, CABG may constitute a valuable alternative to transplantation in selected patients. In individuals considered not suitable for surgical revascularization, implantation of mechanical circulatory support (MCS) not only appears as a salvage procedure, but also allows for reevaluation of future therapy directions. This article aims at providing an overview of evolving and current surgical practices in patients with end-stage CAD.
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Affiliation(s)
- Michal Szlapka
- Department of Cardiac and Vascular Surgery, MediClin Heart Center Coswig, Coswig, Germany
| | - Roland Hetzer
- Department of Cardiothoracic and Vascular Surgery, Immanuel Cardio Centrum Berlin, Berlin, Germany
| | - Jürgen Ennker
- Department of Cardiac and Vascular Surgery, Heart Center Niederrhein, Krefeld, Germany
| | - Harald Hausmann
- Department of Cardiac and Vascular Surgery, MediClin Heart Center Coswig, Coswig, Germany
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23
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Biffi M, Loforte A, Folesani G, Ziacchi M, Attinà D, Niro F, Pasquale F, Pacini D. Hybrid transcatheter left ventricular reconstruction for the treatment of ischemic cardiomyopathy. Cardiovasc Diagn Ther 2021; 11:183-192. [PMID: 33708491 DOI: 10.21037/cdt-20-265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Left ventricular (LV) enlargement is a mechanical adaptation to accommodate LV systolic inefficiency following an acute damage or a progressive functional deterioration, which fails to correct the decline of stroke volume in the long term, leading to progressive heart failure (HF). Surgical ventricular reconstruction (SVR) is a treatment for patients with severe ischemic HF aiming to restore LV efficiency by volume reduction and LV re-shaping. Recently, a new minimally-invasive hybrid technique for ventricular reconstruction has been developed by means of the Revivent™ system (BioVentrix Inc., San Ramon, CA, USA). The device for ventricular reconstruction consists of anchor pairs that enable plication of the anterior and free wall LV scar against the right ventricular (RV) septal scar of anteroseptal infarctions to decrease cardiac volume without ventriculotomy in a beating-heart minimally-invasive procedure, consisting of a transjugular and left thoracotomy approach. Patients with severe (Grade 4) functional mitral regurgitation (FMR) or with previous cardiac surgery procedures were excluded. Outcome of the reconstruction procedure: from 2012 until 2019, it has been applied to 203 patients, with 5 (2.5%) in-hospital deaths. LV volume reduction varied according to experience gained along years: LV end-systolic volume index decreased from baseline 43% (post-market registry) vs. 27% (CE-mark study); left ventricular ejection fraction (LVEF) increased from baseline 25% (post-market registry) vs. 16% (CE-mark study). Clinical status (NYHA class, HF questionnaire, 6-minute walking test) improved significantly compared to baseline, and re-hospitalization rate was only 13% at 6-month follow-up (60% of patients in NYHA =3). FMR grade decreased at follow-up in 63%, while it was unchanged in 37% of patients. The hybrid ventricular reconstruction (HVR) seems a promising treatment for HF patients who may benefit from LV volume reduction, with reasonable mortality and good results at follow-up. A baseline less severe clinical profile was not associated to better outcome at follow-up, which makes the procedure feasible in patients with very large ventricles and depressed ejection fraction (EF). LV reshaping has no detrimental effect on FMR, that may, on the contrary, benefit owing to less papillary muscle displacement, partial recovery of torsion dynamics and of myofibers re-orientation. A controlled study on top of optimal medical treatment is warranted to confirm its role in the management of HF patients.
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Affiliation(s)
- Mauro Biffi
- Department of Cardiology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonio Loforte
- Department of Cardiac Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gianluca Folesani
- Department of Cardiac Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Ziacchi
- Department of Cardiology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Domenico Attinà
- Department of Radiology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fabio Niro
- Department of Radiology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ferdinando Pasquale
- Department of Cardiology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Davide Pacini
- Department of Cardiac Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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24
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Doenst T, Velazquez EJ, Michler RE. Restoring ventricular restoration: A call to re-evaluate a surgical therapy considered ineffective. J Card Surg 2021; 36:693-695. [PMID: 33438826 DOI: 10.1111/jocs.15316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Abstract
The technique of surgical restoration of postischemically dilated left ventricles (SVR) has almost disappeared from operating theaters after the Surgical Treatment of IsChemic Heart failure (STICH) Trial demonstrated no treatment effect in patients with CAD and ejection fraction below 35%. Criticism on the trial was expressed stating that surgical expertise and patient selection (i.e., almost no aneurysm patients included) may have been inadequate to test the procedure s potential. Gaudino and colleagues now propose to conduct an analysis comparing the STICH patient population to a group of comparable SVR patients treated by a center with documented specific expertise for this technique. We here address the background of the trial and the following controversy and suggest a rationale why the suggested analysis has the potential to add valuable information to the field.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Eric J Velazquez
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Robert E Michler
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA
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25
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Kainuma S, Miyagawa S, Toda K, Yoshikawa Y, Hata H, Yoshioka D, Kawamura T, Kawamura A, Kashiyama N, Ito Y, Iseoka H, Ueno T, Kuratani T, Nakamoto K, Sera F, Ohtani T, Yamada T, Sakata Y, Sawa Y. Long-term outcomes of autologous skeletal myoblast cell-sheet transplantation for end-stage ischemic cardiomyopathy. Mol Ther 2021; 29:1425-1438. [PMID: 33429079 PMCID: PMC8058489 DOI: 10.1016/j.ymthe.2021.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/30/2020] [Accepted: 01/02/2021] [Indexed: 12/11/2022] Open
Abstract
We evaluated the cardiac function recovery following skeletal myoblast cell-sheet transplantation and the long-term outcomes after applying this treatment in 23 patients with ischemic cardiomyopathy. We defined patients as “responders” when their left ventricular ejection fraction remained unchanged or improved at 6 months after treatment. At 6 months, 16 (69.6%) patients were defined as responders, and the average increase in left ventricular ejection fraction was 4.9%. The responders achieved greater improvement degrees in left ventricular and hemodynamic function parameters, and they presented improved exercise capacity. During the follow-up period (56 ± 28 months), there were four deaths and the overall 5-year survival rate was 95%. Although the responders showed higher freedom from mortality and/or heart failure admission (5-year, 81% versus 0%; p = 0.0002), both groups presented an excellent 5-year survival rate (5-year, 93% versus 100%; p = 0.297) that was higher than that predicted using the Seattle Heart Failure Model. The stepwise logistic regression analysis showed that the preoperative estimated glomerular filtration rate and the left ventricular end-systolic volume index were independently associated with the recovery progress. Approximately 70% of patients with “no-option” ischemic cardiomyopathy responded well to the cell-sheet transplantation. Preoperative renal and left ventricular function might predict the patients’ response to this treatment.
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Affiliation(s)
- Satoshi Kainuma
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan.
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Hiroki Hata
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Takuji Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Ai Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Noriyuki Kashiyama
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Yoshito Ito
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Hiroko Iseoka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Takayoshi Ueno
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Kei Nakamoto
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Fusako Sera
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tomomi Yamada
- Department of Medical Innovation, Osaka University Hospital, Suita, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan.
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26
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Shipulin VM, Pryakhin AS, Andreev SL, Shipulin VV, Kozlov BN. Results of reconstructive interventions in patients with ischemic cardiomyopathy. Asian Cardiovasc Thorac Ann 2020; 29:508-517. [PMID: 33342244 DOI: 10.1177/0218492320983464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Effective treatment of patients with ischemic cardiomyopathy is one of the most difficult issues in contemporary cardiac surgery. The aim of this study was to evaluate the long-term effectiveness of reconstructive interventions on the left ventricle during chronic heart failure in patients with ischemic cardiomyopathy. METHODS Between March 2013 and December 2017, 178 patients underwent surgical treatment for ischemic cardiomyopathy. Isolated coronary artery bypass grafting was compared with coronary artery bypass grafting with left ventricular reconstruction, using propensity score matching analysis. The primary endpoints of the study were hospital mortality and long-term survival. RESULTS After propensity score matching, 29 pairs of patients were compared. The 30-day hospital mortality was comparable (6.8% versus 6.8%, p = 0.952), the average follow-up was 37.4 ± 12.6 months, with no statistically significant difference in mortality from all causes (p = 0.352). After coronary artery bypass in combination with left ventricular reconstruction, patients showed a statistically significant decrease in clinical and functional indicators of chronic heart failure compared to those who had coronary artery bypass grafting alone, in terms of peak oxygen consumption (15.3 versus 13.5 mL·kg-1·min-1, p = 0.043) and N-terminal pro-brain natriuretic peptide concentrations (298.6 versus 461.1 pg·mL-1, p = 0.032). CONCLUSIONS Compared to isolated coronary artery bypass, coronary artery bypass in combination with left ventricular reconstruction for the treatment of ischemic cardiomyopathy leads to a significant decrease in the clinical and functional parameters of chronic heart failure in the long-term postoperative period.
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Affiliation(s)
- Vladimir M Shipulin
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Andrey S Pryakhin
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Sergey L Andreev
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Vladimir V Shipulin
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Boris N Kozlov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
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27
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Castelvecchio S, Milani V, Volpe M, Citarella M, Ambrogi F, Boveri S, Saitto G, Garatti A, Menicanti L. Comparable outcomes between genders in patients undergoing surgical ventricular reconstruction for ischaemic heart failure. ESC Heart Fail 2020; 8:291-299. [PMID: 33169941 PMCID: PMC7835569 DOI: 10.1002/ehf2.13039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/06/2020] [Accepted: 09/15/2020] [Indexed: 01/18/2023] Open
Abstract
Aims Female sex and heart failure (HF) are considered poor prognostic factors for surgery. We aimed to investigate the association between sex and surgical outcomes in patients with ischaemic HF undergoing surgical ventricular reconstruction and coronary artery bypass grafting. Methods and results From July 2001 to June 2017, 648 patients [111 women (17%) and 537 men (83%)] were referred to our centre. Follow‐up continued through June 2018. All patients underwent surgical ventricular reconstruction; coronary artery bypass grafting was performed in 582 patients (90%). Primary outcome was defined as all‐cause mortality. Secondary outcome included all‐cause mortality or all‐cause hospitalization. Women were older (70 vs. 65 years, P < 0.0001) with lower body surface area (1.70 vs. 1.86 m2, P < 0.0001). Women had more diabetes (36% vs. 24%, P = 0.005) and a higher New York Heart Association classification (Class III/IV 65.7% vs. 47.8%, P = 0.0006), without any significant difference in medical therapy except for a higher use of oral antidiabetic agents in women (P = 0.029). At baseline, the left ventricular (LV) end‐diastolic volume index was significantly lower in women [median 107.06 (80.6–127.81) vs. 113. 04 (94.33–135.52) mL/m2, P = 0.0078] but not the LV end‐systolic volume index (ESVI) [median 73.45 (51.93–96.79) vs. 77.03 (60.33–95.71) mL/m2, P = 0.1393] and the ejection fraction (median 31% vs. 32%, P = 0.150). Women had a higher rate of anterior remodelling (90.9% vs. 79.1%, P = 0.0129), without evidence of differences in mitral valve insufficiency (P = 0.761 for Grade 0 to 4) and mitral surgery (P = 0.810). After surgery, the percentage of reduction in LV ESVI was higher in women than in men (median ΔLV ESVI −42.06 vs. −31.99, P = 0.0003). Mortality within 30 days occurred in 43 patients (6.64%): 12 women (10.81%) and 31 men (5.77%, P = 0.0522). Over a median follow‐up of 9.8 years, all‐cause mortality occurred in 269 patients (41.64%), without significant difference between women (45.9%) and men (40.7%). There was no evidence of difference of all‐cause death between sexes (log‐rank = 0.2441). When considering mortality and first hospitalization as competing events, Gray's test showed no difference of cumulative incidence functions (all‐cause hospitalization, all‐cause death, and combined endpoint) according to sex (P = 0.909, P = 0.445, and P = 0.429, respectively). Conclusions In this study, long‐term outcomes for women and men with ischaemic HF undergoing complex cardiac surgery were equivalent. Albeit older and more symptomatic, women should not be denied this type of cardiac surgery.
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Affiliation(s)
| | - Valentina Milani
- Scientific Directorate, IRCCS Policlinico San Donato, Milan, Italy
| | - Marianna Volpe
- Department of Cardiac Rehabilitation, IRCCS Policlinico San Donato, Milan, Italy
| | - Michele Citarella
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Federico Ambrogi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Sara Boveri
- Scientific Directorate, IRCCS Policlinico San Donato, Milan, Italy
| | - Guglielmo Saitto
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Andrea Garatti
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Lorenzo Menicanti
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
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28
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Pillay T, Neves P, Benetti F, Van Bladel K, Wechsler A, Annest L. Minimal access left ventricular reconstruction. J Card Surg 2020; 36:300-306. [PMID: 33135236 DOI: 10.1111/jocs.15117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 11/30/2022]
Abstract
The Revivent TC™ Transcatheter Ventricular Enhancement System (BioVentrix Inc.) is intended for use in heart failure with cardiac dysfunction a previous myocardial infarction. The resultant increased left ventricular systolic volume and discrete, contiguous, noncontractile (akinetic and/or dyskinetic) scar located in the anteroseptal, apical (may extend laterally) region of the left ventricle (LV) lends itself to Revivent. The procedure, called Less Invasive Ventricular Enhancement, consists of the implantation of a series of microanchors pairs to exclude the scarred myocardium, to reduce and reshape the LV. We present the procedure step-by-step, as team coordination between the cardiac surgeon and the interventional cardiologist is essential to ensure good procedural outcomes. This is a novel and new technique to address heart failure secondary to myocardial infarction.
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Affiliation(s)
| | - Paulo Neves
- BioVentrix Inc., San Ramon, California, USA.,Department of Cardiothoracic Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | | | - Andrew Wechsler
- BioVentrix Inc., San Ramon, California, USA.,Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Lon Annest
- BioVentrix Inc., San Ramon, California, USA
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29
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Adhyapak SM, Parachuri VR. Is programmed electrical stimulation mandatory for recognition of ventricular arrhythmogenicity in heart failure? Indian J Thorac Cardiovasc Surg 2020; 36:52-55. [PMID: 33061094 DOI: 10.1007/s12055-019-00839-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/28/2022] Open
Abstract
Ischemic cardiomyopathy often presents with advanced heart failure necessitating an intensive multidisciplinary approach to management. These patients constitute a very difficult population presenting with angina and ventricular tachyarrhythmias sometimes presenting as sudden cardiac death. In those patients presenting with spontaneous ventricular tachyarrhythmias, treatment with automated intracardiac defibrillator implantation has a significant mortality benefit. In patients with significant left ventricular (LV) dilatation and a left ventricular ejection fraction ≤ 30%, guidelines state that device implantation should be preceded by programmed electrical stimulation, which demonstrates inducible ventricular tachyarrhythmia. The treatment options for patients with moderate LV dilatation and ejection fraction ≥ 30% is individualized. Devices have their associated problems. Radiofrequency ablation has mixed results. Surgical cryoablation when performed concomitantly with surgical ventricular restoration has shown promising results. But, this option remains isolated to patients eligible for surgical ventricular restoration. Programmed electrical stimulation for inducibility of ventricular tachyarrhythmias in these patients also has a questionable role. The need for programmed electrical stimulation prior to cryoablation also seems highly individualized. In this review, we discuss the mechanisms of ischemic ventricular tachyarrhythmias and treatment options in heart failure. The mechanisms of ventricular arrhythmogenesis in ischemic cardiomyopathy help in formulating novel technical modifications for cryoablation when performed concomitantly with surgical ventricular restoration.
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30
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Adhyapak SM, Menon PG, Parachuri VR, Michael J, Thomas T. Surgical ventricular restoration-meta-analysis of observational studies. Indian J Thorac Cardiovasc Surg 2020; 36:347-355. [PMID: 33061142 DOI: 10.1007/s12055-019-00902-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/24/2019] [Accepted: 11/07/2019] [Indexed: 11/27/2022] Open
Abstract
Background Technique of surgical ventricular restoration (SVR) may impact its outcomes. Therefore, we conducted a meta-analysis of studies on SVR performed by using different techniques and studied outcomes. Methods Scientific databases were searched for studies on SVR. End points assessed were NYHA class, left ventricular ejection fraction (LVEF), end-systolic volume index (ESVI), sphericity index, apical rotations, mortality, and re-admissions for heart failure. Results Circular patch use showed significant increases in LVEF by 9.53% (7.62, 11.45), decreases in ESVI by - 35.16 ml (- 44.97, - 25.34), improvements in NYHA class by - 1.29 (- 1.45, - 1.13), and decreases in sphericity index by - 0.04 (- 0.08, 0.00) . In studies using rectangular patch, the LVEF showed an increase by 5.75% (3.52, 7.98,), the NYHA class improved by - 2.45 (- 2.59, - 2.32). The decrease in ESVI was - 40.36 ml (- 62.2, - 18.52). The apical rotation increased by 3.45 0 (0.62, 6.29,). Re-admission for heart failure and mortality was less.When the magnitude of ESVI decrease were compared within studies using rectangular patch, the greatest decrease in ESVI was notedwith use of a rectangular patch. (- 59 ml versus - 40 ml a very narrow patch and - 22 ml use of oval patch) The improvements in sphericity index at 2 years in use of rectangular patch study was - 0.78 ± 0.11 versus 0.00 ± 0.03 in use of oval patch study. Conclusions Rectangular patch use resulted in maximal decreases in ESVI and sphericity index. Mortality and re-admissions for heart failure were also significantly less at mid-term after SVR.
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Affiliation(s)
| | - Prahlad Gopalakrishna Menon
- Carlow University (Dept of Mathematics & Data Analytics), University of Pittsburgh (Dept of Bioengineering), Pittsburgh, PA USA
| | - Venkateswara Rao Parachuri
- Department of Cardiothoracic Surgery, Narayana Hrudayalaya Institute of Medical Sciences, Bengaluru, India
| | - John Michael
- Dept of Biostatistics, St. John's Research Institute, Bengaluru, India
| | - Tinku Thomas
- Dept of Biostatistics, St. John's Research Institute, Bengaluru, India
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31
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Goyal A, Krishnaswamy A. Percutaneous Valve Interventions in Heart Failure. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00841-x] [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] [Indexed: 02/07/2023]
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32
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Fuchs M, Schibilsky D, Zeh W, Berchtold-Herz M, Beyersdorf F, Siepe M. Does the heart transplant have a future? Eur J Cardiothorac Surg 2020; 55:i38-i48. [PMID: 31106338 PMCID: PMC6537946 DOI: 10.1093/ejcts/ezz107] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/29/2019] [Accepted: 02/15/2019] [Indexed: 12/11/2022] Open
Abstract
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Heart failure has remained the leading cause of death globally for the last 15 years—and its prevalence will continue to rise. Fifty years ago, heart failure management was enriched by the possibility of a heart transplant. Despite impressive improvements in medical treatment for heart failure, a heart transplant remains the most effective long-lasting treatment for advanced heart failure in terms of mortality and quality of life. However, donor and recipient characteristics have changed dramatically in recent years, leading to more complex decision-making regarding organ acceptance and to more demanding operations and postoperative management. With improving pathophysiological understanding in the last decades, today’s scientific interest still focuses on basic knowledge. How to retrieve and conserve organs to minimize ischaemic injury; how best to allocate them, considering the likelihood of success (developing a heart-allocation scoring system similar to that for lung allocation); how to match donor/recipient characteristics (ABO blood-group antigen compatibility versus incompatibility); and how to avoid graft failure, rejection and secondary morbidities such as malignomas and cardiac allograft vasculopathy after the heart transplant—all these factors remain fundamental challenges in today’s transplant medicine. The use of ex vivo perfusion (e.g. via the Organ Care System®, TransMedics, Andover, MA, USA) may play an important role in this change. Remarkably, there are huge regional divergences in current transplant practices: Whereas the number of transplants continues to rise in most Eurotransplant countries and other major transplant networks, there are some countries in which transplant numbers are static or even dropping (as in Germany). This difference results in wide variations across different countries as to how advanced heart failure is treated using mechanical circulatory-assist devices.
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Affiliation(s)
- Matthias Fuchs
- Department of Cardiovascular Surgery, Heart Center University Freiburg - Bad Krozingen, Bad Krozingen, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Corresponding author. Department of Cardiovascular Surgery, Heart Center University Freiburg - Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany. Tel: +49-7633-4020; fax: +49-7633-4029909; e-mail: (M. Fuchs)
| | - David Schibilsky
- Department of Cardiovascular Surgery, Heart Center University Freiburg - Bad Krozingen, Bad Krozingen, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfgang Zeh
- Department of Cardiovascular Surgery, Heart Center University Freiburg - Bad Krozingen, Bad Krozingen, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Berchtold-Herz
- Department of Cardiovascular Surgery, Heart Center University Freiburg - Bad Krozingen, Bad Krozingen, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Center University Freiburg - Bad Krozingen, Bad Krozingen, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Heart Center University Freiburg - Bad Krozingen, Bad Krozingen, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Khan I. A review of the Surgical Treatment for Ischemic Heart Failure trial. Asian Cardiovasc Thorac Ann 2020; 28:633-637. [PMID: 32870026 DOI: 10.1177/0218492320957162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Optimal treatment for patients with ischemic heart disease and severe left ventricular dysfunction is a debatable subject in the literature. The largest and only trial on the subject so far is the Surgical Treatment for Ischemic Heart Failure trial. This trial compared coronary artery bypass grafting with optimal medical treatment in one arm versus coronary artery bypass grafting with surgical ventricular restoration in the second arm. Recently, the 10-year follow-up data of various subsets of the trial have been published. This study reviews various pertinent clinical issues related to the trial and its sub-studies and their relevance in routine modern-day clinical practice.
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Affiliation(s)
- Imran Khan
- Department of Cardiothoracic Surgery, Al Mana General Hospital, Al Khobar, Saudi Arabia
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Fukui M, Sorajja P, Gössl M, Bae R, Lesser JR, Sun B, Duncan A, Muller D, Cavalcante JL. Left Ventricular Remodeling After Transcatheter Mitral Valve Replacement With Tendyne. JACC Cardiovasc Interv 2020; 13:2038-2048. [DOI: 10.1016/j.jcin.2020.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 02/08/2023]
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Chamogeorgakis T, Kostopanagiotou K, Behler A, Apostolou D. HeartMate 3 left ventricular assist device implant after excision of a large apical aneurysm. Proc (Bayl Univ Med Cent) 2020; 33:455-456. [PMID: 32675986 DOI: 10.1080/08998280.2020.1759334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022] Open
Abstract
The presence of a left ventricular apical aneurysm may pose a technical challenge during implantation of a left ventricular assist device (LVAD). We describe implantation of a HeartMate III LVAD under cardioplegic arrest. A ventricular aneurysmectomy was performed and the LVAD was implanted at the left ventricular apex at the level of the transition zone between the scar tissue and the viable myocardium. Two pursestring 2-0 Prolene Fontan sutures were placed circumferentially at the transition zone to make up for the size discrepancy between the left ventricular opening and the HeartMate 3 pump. The echocardiographic analysis demonstrated optimal inflow cannula orientation, and the patient had an uneventful recovery.
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Affiliation(s)
| | | | - Allison Behler
- Division of Cardiac Surgery, Henry Ford HospitalDetroitMichigan
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Behnes M, Schupp T, Mashayekhi K, Akin I. 'Off-pump' left ventricular reconstruction - A causal and less invasive surgical option for patients with advanced systolic heart failure? Eur J Heart Fail 2020; 22:581-583. [PMID: 32086997 DOI: 10.1002/ejhf.1737] [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: 11/19/2019] [Revised: 11/27/2019] [Accepted: 12/04/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Tobias Schupp
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
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Bonios MJ, Kogerakis N, Adamopoulos SN. Left ventricular volume reduction and reshape - 'Re-STICHING' the field. Letter regarding the article 'Less invasive ventricular reconstruction for ischaemic heart failure'. Eur J Heart Fail 2020; 22:1053. [PMID: 31975568 DOI: 10.1002/ejhf.1748] [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: 12/24/2019] [Accepted: 12/29/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Michael J Bonios
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Nektarios Kogerakis
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece
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Klein P, Anker SD, Wechsler A, Skalsky I, Neuzil P, Annest LS, Bifi M, McDonagh T, Frerker C, Schmidt T, Sievert H, Demaria AN, Kelle S. Less invasive ventricular reconstruction for ischaemic heart failure. Eur J Heart Fail 2019; 21:1638-1650. [DOI: 10.1002/ejhf.1669] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/06/2019] [Accepted: 10/11/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Patrick Klein
- Department of Cardiothoracic SurgerySt Antonius Hospital Nieuwegein The Netherlands
| | - Stefan D. Anker
- BIH Center for Regenerative Therapies (BCRT), CharitéUniversitätsmedizin Berlin Berlin Germany
- Division of Cardiology and Metabolism, Department of Cardiology (CVK) Charité, Berlin Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin Germany
| | - Andrew Wechsler
- Department of Cardiothoracic SurgeryDrexel University College of Medicine Philadelphia PA USA
| | - Ivo Skalsky
- Department of Cardiac SurgeryNa Homolce Hospital Prague Czech Republic
| | - Petr Neuzil
- Department of CardiologyNa Homolce Hospital Prague Czech Republic
| | | | - Mauro Bifi
- Intituto di Cardiologia, Azienda OspedalieroUniversitaria di Bologna Bologna Italy
| | | | | | - Tobias Schmidt
- Department of CardiologyAsklepios Klinik St Georg Hamburg Germany
| | - Horst Sievert
- CardioVascular Center Frankfurt Frankfurt am Main Germany
- Anglia Ruskin University Chelmsford UK
| | - Anthony N. Demaria
- Division of Cardiology, Department of MedicineUniversity of California, Sulpizio Cardiovascular Center San Diego CA USA
| | - Sebastian Kelle
- DZHK (German Centre for Cardiovascular Research) Partner Site Berlin Germany
- Department of Internal MedicineCardiology German Heart Center Berlin Berlin Germany
- Department of Internal Medicine/CardiologyCharité Campus Virchow Clinic Berlin Germany
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Castelvecchio S, Pappalardo OA, Menicanti L. Myocardial reconstruction in ischaemic cardiomyopathy. Eur J Cardiothorac Surg 2019; 55:i49-i56. [PMID: 31106339 PMCID: PMC6526097 DOI: 10.1093/ejcts/ezy367] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/07/2018] [Accepted: 09/20/2018] [Indexed: 12/31/2022] Open
Abstract
An increase in left ventricular volume after a myocardial infarction is a key component of the adverse remodelling process leading to chamber dysfunction, heart failure and an unfavourable outcome. Hence, the therapeutic strategies have been designed to reverse the remodelling process by medical therapy, devices or surgical strategies. Surgical ventricular reconstruction primarily combined with myocardial revascularization has been introduced as an optional intervention aimed to reduce the left ventricle through resection of the scar tissue and is recommended in selected patients with predominant heart failure symptoms, and with myocardial scarring and moderate left ventricular remodelling. This review outlines the rationale and the technique for reconstructing the left ventricle and the possible indications for using that technique, based on experiences from the centre with the largest international experience. The major contributions in the literature are briefly discussed.
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Affiliation(s)
- Serenella Castelvecchio
- Department of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Omar Antonio Pappalardo
- 3D and Computer Simulation Laboratory, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Lorenzo Menicanti
- Department of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
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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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Rajakumar AP, Ravikumar MS, Palanisamy V, Raman K, Mohanraj A, Jamesraj J, Kurian VM, Ajit M, Sethuratnam R. Role of surgical ventricular restoration post surgical treatment of heart failure (STICH) trial. Indian J Thorac Cardiovasc Surg 2019; 35:175-185. [PMID: 33061002 DOI: 10.1007/s12055-018-0748-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 08/28/2018] [Accepted: 09/25/2018] [Indexed: 10/27/2022] Open
Abstract
Objective To compare the outcomes of isolated coronary artery bypass grafting (CABG) versus surgical ventricular restoration (SVR) with or without CABG for patients with ischemic cardiomyopathy (ICM). Methods Retrospectively, 49 patients with ICM and severe LV dysfunction (LVEF < 35%) who underwent SVR with or without CABG from January 2009 to December 2016 at a single institution was compared with 49 patients who underwent isolated CABG. The two groups were matched for preoperative clinical and echocardiographic parameters including left ventricular end-diastolic diameter (LVIDd), left ventricular end-systolic diameter (LVIDs), left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV). Primary outcomes analyzed included early mortality, late mortality, and major adverse cardiac or cerebrovascular events (MACCE). Secondary outcomes analyzed included echocardiographic parameters of left ventricular volume and function-indexed left ventricular end-diastolic volume (LVEDVi), indexed left ventricular end-systolic volume (LVESVi), and LVEF. Cox and survival analysis was performed. Results Early and late mortality in SVR vs. CABG groups were 4 (8.1%) and 6 (12.2%) vs. 1 (2%) and 5 (10.2%) respectively. Mean improvement in LVEF was 3.39 ± 7.51 compared to 4.97 ± 5.45 between the two groups at 3-month follow-up. Mean improvement in LVEF was 5.1 ± 8.3 in the SVR group vs 5.9 ± 7.1 in the CABG group at the last follow-up. There was no statistically significant improvement between the two groups in terms of LVEF at 3 months or the last follow-up. There were statistically significant differences between LVEDVi and LVESVi between the two groups at 3 months and the last follow-up. The 5-year rates of survival were 85 ± 6 and 82 ± 9% for SVR and CABG groups respectively. The 5-year rates of freedom from MACCE were 75 ± 7 and 60 ± 11% for SVR and CABG groups respectively. Conclusion Compared with isolated CABG, SVR plus CABG results in equivalent late mortality and better left ventricular reverse remodeling (as evidenced by LV volume reduction) and better freedom from MACCE at 5-year follow-up.
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Affiliation(s)
- Anjith Prakash Rajakumar
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Mithun Sundararaaja Ravikumar
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Vijayanand Palanisamy
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Karthik Raman
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Anbarasu Mohanraj
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Jacob Jamesraj
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Valikapthalil Mathew Kurian
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Mullasari Ajit
- Department of Cardiology, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Rajan Sethuratnam
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
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Loforte A, Alfonsi J, Gliozzi G, Folesani G, Fiorentino M, Biffi M, Marinelli G, Di Bartolomeo R, Pacini D. Less invasive ventricular enhancement (LIVE) as potential therapy for ischaemic cardiomyopathy end-stage heart failure. J Thorac Dis 2019; 11:S921-S928. [PMID: 31183171 DOI: 10.21037/jtd.2019.02.86] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Surgical ventricular reshaping (SVR) is a treatment option for patients with severe ischaemic heart failure (HF). Recently, a new minimally invasive, hybrid technique named "less invasive ventricular enhancement" (LIVE), has been developed adopting the Reviven™ Myocardial Anchoring System (BioVentrix Inc., San Ramon, CA, USA). Methods Between January 2015 and November 2018, 7 patients (5 men and 2 women; mean age 72±8.9 years) underwent LIVE procedure at our institution. Results Procedural success was 100%. A total anchors number of 3.0±0.9 was used to reshape the left ventricle (LV). Preoperative and postoperative echocardiographic assessments showed an increase of LV ejection fraction (EF) from 22.8%±8.1% to 35%±7.2% (P=0.001) and a decrease of LV volumes in terms of LV end-systolic volume index (LVESVI), from 93.2±10.5 to 52.1±15.1 mL/m2 (P<0.001), and LV end-diastolic volume index LVEDVI, from 137.2±20.1 to 78±10.2 mL/m2 (P=0.001), respectively. In all patients functional mitral regurgitation (MR) prior to surgery decreased significantly after LIVE procedure. In 1 patient, the occurrence of right ventricle perforation required correction through a standard sternotomy. All patients survived the surgical procedure. The mean duration of intensive care unit stay was 7.8 days (range, 1-22 days), and the mean length of hospital stay was 22.1 days (range, 9-45 days). Mean follow-up (FU) time was 189.7±104.5 days. Average NYHA functional class at FU was 1.4±0.9 compared to 3.4±0.6 preoperatively (P=0.001). All patients were in satisfactory clinical condition and resumed their own daily activities. Echocardiographic monitorings at FU were stable and comparable to the above mentioned results at discharge. Conclusions In high-risk patients and selected cases, LIVE procedure may be advantageous both technically and clinically. Preliminary results of this novel hybrid treatment for symptomatic ischaemic cardiomyopathy are encouraging, in terms of significant improvement in LV EF, reduction in LV volumes and functional MR grade.
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Affiliation(s)
- Antonio Loforte
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Jacopo Alfonsi
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Gregorio Gliozzi
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Gianluca Folesani
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Mariafrancesca Fiorentino
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Mauro Biffi
- Department of Cardiology, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Giuseppe Marinelli
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Roberto Di Bartolomeo
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Davide Pacini
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
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Petrus AHJ, Klein P, Tops LF, Dekkers OM, Hoogervorst LA, Couperus LE, Beeres SLMA, Klautz RJM, Braun J. 10-Year Outcomes After Left Ventricular Reconstruction: Rethinking the Impact of Mitral Regurgitation. Ann Thorac Surg 2019; 108:81-88. [PMID: 30710521 DOI: 10.1016/j.athoracsur.2019.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/03/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Heart failure with reduced ejection fraction due to a post-infarction anteroseptal aneurysm carries a poor prognosis. Patients with refractory heart failure may be considered for advanced surgery, including left ventricular assist device implantation, heart transplantation and left ventricular reconstruction. The aim of this study was to evaluate outcomes after an integrated approach of left ventricular reconstruction with concomitant procedures (mitral/tricuspid valve repair, coronary revascularization), and assess risk factors for event-free survival, focusing on left ventricular geometry/function and presence of functional mitral regurgitation (MR). METHODS A total of 159 consecutive heart failure patients who underwent left ventricular reconstruction between 2002 and 2011 were included. Mid-term echocardiographic and long-term clinical outcomes were evaluated. Preoperative risk factors were correlated to event-free survival (freedom from mortality, left ventricular assist device implantation, and heart transplantation). RESULTS Mid-term echocardiography demonstrated decreased indexed left ventricular end-systolic volumes (89 ± 42 mL/m2 preoperatively; 51 ± 18 at mid-term, p < 0.001), and absence of MR ≥ grade 2. Event-free survival was 83% ± 3% at 1-year, 68% ± 4% at 5-year, and 46% ± 4% at 10-year follow-up. Preoperative wall motion score index (WMSI; hazard ratio [HR] 3.1, 95% confidence interval [CI] 1.7-5.8, p < 0.001) and presence of MR ≥ grade 2 (HR 1.9, 95% CI 1.1-3.1, p = 0.014) were independently associated with adverse event-free survival. CONCLUSIONS Event-free survival is favorable in patients with WMSI < 2.5 and significantly worse when WMSI is ≥ 2.5. In both groups, the presence of preoperative MR ≥ grade 2 negatively affects event-free survival, despite successful correction of MR. Risk stratification by preoperative WMSI and MR grade supports the Heart team in choosing the optimal surgical strategy for patients with refractory heart failure.
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Affiliation(s)
- Annelieke H J Petrus
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lotje A Hoogervorst
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Lotte E Couperus
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Saskia L M A Beeres
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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Long-Term Survival and Echocardiographic Findings After Surgical Ventricular Restoration. Ann Thorac Surg 2018; 107:1754-1760. [PMID: 30586580 DOI: 10.1016/j.athoracsur.2018.11.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/08/2018] [Accepted: 11/26/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study investigates the long-term survival and durability of mitral procedures on patients undergoing surgical ventricular restoration. METHODS From 1992 to 2017, 109 patients underwent surgical ventricular restoration. Survival was determined from hospital records and the National Death Index. Preoperative demographics, clinical characteristics and features, operative technique, and follow-up echocardiography findings were analyzed using Cox regression and log-rank to determine variables influencing survival. RESULTS The mean age was 61.57 ± 12.81 years. There were 101 (93%) true and 8 (7%) pseudo-aneurysms. Concomitant surgeries included mitral valve (MV) repair (n = 40, 37%), MV replacement (n = 5, 5%), tricuspid valve repair (n = 4, 4%), aortic valve replacement (n = 3, 3%), coronary bypass grafting (n = 76, 70%; 1.6 ± 1.3 grafts), and ventricular septal defect closure (n = 5, 5%). Redo-sternotomies were performed in 12 patients (11%). Median duration of echocardiographic follow up was 2.9 years (interquartile range, 9.0) and was obtained in 59 patients (54%). Left ventricular ejection fraction improved from 28% ± 13% to 33% ± 16% (p = 0.011). Median duration of echocardiographic follow-up of MV repair was 3.6 years (interquartile range, 9.5). MV repair led to sustained improvements in mitral regurgitation (MR; p = 0.001) where only 2 (5%) experienced recurrence of moderate to severe MR. For patients who did not undergo an MV procedure there was no difference in preoperative and follow-up MR severity (p = 0.586). Median patient follow-up was 7.1 years (interquartile range, 8.5). Overall 5-, 10-, and 15-year survival rates were 71.9%, 48.1%, and 26.2%, respectively. CONCLUSIONS Surgical ventricular restoration was associated with sustained improvement in left ventricular ejection fraction with almost half surviving to 10 years postoperatively. For patients undergoing concomitant MV repair, the improvement in mitral competence is durable.
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Doulamis IP, Perrea DN, Mastrokostopoulos G, Drakopoulou K, Voutetakis K, Tzani A, Chloroyiannis IA. A single center's experience with total arterial revascularization and spiral aneurysmorrhaphy for ischemic cardiac disease. Heart Vessels 2018; 34:906-915. [PMID: 30523442 DOI: 10.1007/s00380-018-1317-z] [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] [Received: 09/05/2018] [Accepted: 11/30/2018] [Indexed: 11/30/2022]
Abstract
The restoration of left ventricular (LV) geometry in combination with coronary artery bypass grafting for the treatment of ischemic cardiac disease remains controversial. We hereby present the experience of our center with total arterial myocardial revascularization (TAMR) and spiral aneurysmorrhaphy for ischemic heart disease. A retrospective analysis of 101 patients with advanced cardiovascular disease who underwent TAMR and spiral aneurysmorrhaphy was performed. Spiral aneurysmorrhaphy is a modification of the linear aneurysmorrhaphy and was applied to patients who had a LV aneurysm with a diameter of less than 5 cm. Peri-operative and in-hospital data were retrieved. The majority of the patients were male (87.13%) with a mean age of 63.1 years. Mean pre-operative ejection fraction (EF) was 35.7% ranging between 20 and 65%. An average of 3.23 grafts was required per patient. Early mortality was 6.93% (one intra-operative and six in-hospital deaths). Addition of concomitant valve surgery was associated with prolonged total operative, cardiopulmonary bypass and cross-clamp time (p < 0.001), increased need for blood (p = 0.012) and plasma (p = 0.038), longer intensive care unit (ICU) stay (p = 0.045) and higher rate of post-operative cerebrovascular accident (p = 0.011). Furthermore, patients with a pre-operative EF between 30 and 50% had a shorter ICU stay (p = 0.045) and LoS (p = 0.029) compared with patients with EF <30%. Early mortality and post-operative complication rates following this combined procedure are in consistency with the relevant available data suggesting its feasibility regardless of the EF or addition of concomitant surgeries. Data from the follow-up of these patients are required to examine the long-term efficacy of this surgical modality.
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Affiliation(s)
- Ilias P Doulamis
- Laboratory for Experimental Surgery and Surgical Research "N.S Christeas", Athens Medical School, National and Kapodistrian University of Athens, Agiou Thoma Str., 15b, Goudi, 11527, Athens, Greece.
| | - Despina N Perrea
- Laboratory for Experimental Surgery and Surgical Research "N.S Christeas", Athens Medical School, National and Kapodistrian University of Athens, Agiou Thoma Str., 15b, Goudi, 11527, Athens, Greece
| | | | | | | | - Aspasia Tzani
- Laboratory for Experimental Surgery and Surgical Research "N.S Christeas", Athens Medical School, National and Kapodistrian University of Athens, Agiou Thoma Str., 15b, Goudi, 11527, Athens, Greece
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Abstract
The Dor procedure was historically used to restore the geometry of the heart in a patient with a left ventricular (LV) aneurysm via reduction and reshaping of the LV with an aneurysmectomy. Unfortunately, morbidity and mortality remain high with this procedure, with many patients little to no recovery of their ejection fraction while developing severe diastolic failure, often requiring further support; however, the natural history of these patients remains largely unknown. Heart transplant has long been considered the most durable of treatment for patients with end-stage heart failure (HF), but because of the scarcity of donor hearts, the implantation of left ventricular assist devices (LVAD) for mechanical circulatory support has also proven to be an essential tool in the treatment of the advanced heart failure patient. While various techniques for LVAD implantation have been well outlined, there is very limited literature on placement of a VAD in patients with a history of LV aneurysmectomy or Dor procedures, particularly with regard to the challenging aspects of apical cannulation in those with prior apical ventriculotomy and patch placement. In this series, we describe three patients with a history of LV aneurysmectomy procedures who underwent Heartware ventricular assist device (HVAD) implantations for end-stage HF.
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Doulamis IP, Perrea DN, Chloroyiannis IA. Left ventricular reconstruction surgery in ischemic heart disease: a systematic review of the past two decades. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 60:422-430. [PMID: 30465416 DOI: 10.23736/s0021-9509.18.10647-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The aim of this paper is to systematically review the existing literature reporting on patients recruited during the past twenty years regarding the role of left ventricular (LV) reconstruction in ischemic cardiomyopathy in terms of efficacy and mortality and provide an updated overview of the current evidence. EVIDENCE ACQUISITION The PubMed and Cochrane bibliographical databases were thoroughly searched for the following MeSH terms: "ventricular reconstruction" OR ventriculoplasty OR "ventricular aneurysm" OR "ventricular restoration." Original studies -recruiting patients during the past twenty years- on LV reconstruction surgery in more than five cases and reporting on the associated peri- or postoperative mortality were deemed eligible. EVIDENCE SYNTHESIS Twenty-seven studies were included and provided data for 3220 patients with a mean age of 61 years. Angina was present in 66.6% (510/766) of the patients, while nine out of ten (635/699) had a history of myocardial infarction. Average preoperative ejection fraction was 29.9% and end-systolic volume index was 93.6 mL/m2. With respect to complications, low cardiac output syndrome and the need for intra-aortic balloon pump were prevalent in 9.3% (79/850) and 18.8% (334/1773), respectively. Thirty-day mortality was 7.1% (230/3220) and late-mortality (mean follow-up of 36.9 months) was 19.6% (548/2791), while the rate of MACCE was 40.1% (367/915). Five-year mortality was 29% (340/1171). CONCLUSIONS Our findings provide a current perspective of the role of LV reconstruction in the treatment of ischemic cardiomyopathy suggesting its benefit in survival. Taking into consideration the existing debate, further studies are required so that a solid conclusion to be made.
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Affiliation(s)
- Ilias P Doulamis
- Laboratory for Experimental Surgery and Surgical Research, N.S. Christeas School of Medicine, National and Kapodistrian University of Athens, Athens, Greece -
| | - Despina N Perrea
- Laboratory for Experimental Surgery and Surgical Research, N.S. Christeas School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Guidelines for the Prevention, Detection, and Management of Heart Failure in Australia 2018. Heart Lung Circ 2018; 27:1123-1208. [DOI: 10.1016/j.hlc.2018.06.1042] [Citation(s) in RCA: 203] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Yan J, Jiang SL. Impact of surgical ventricular restoration on early and long-term outcomes of patients with left ventricular aneurysm: A single-center experience. Medicine (Baltimore) 2018; 97:e12773. [PMID: 30313093 PMCID: PMC6203510 DOI: 10.1097/md.0000000000012773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Left ventricular aneurysm (LVA) is a common complication of myocardial infarction. However, the optimal treatment for LVA remains controversial.In this retrospective study, we analyzed the early and long-term clinical consequences of surgical ventricular restoration on 102 patients who had undergone repair between January, 2005 and January, 2015. The LVA repair approaches comprised of patch plasty (n = 28), linear repair (n = 40), and plication repair (n = 34).Patient demographics were 60.8% male, and the mean age was 60.5 ± 7.2 years. The in-hospital mortality rate was 7.8% (8/102), including 6 patients who died from low cardiac output and 2 from multiorgan failure. During the early postoperative period, left ventricular sizes significantly decreased in the patch plasty and linear repair groups compared with the plication group. In addition, all 3 repair techniques greatly ameliorated left ventricular ejection fraction (P < .05), and there was no significant difference in survival rate between groups (P = .25).Surgical ventricular restoration (linear repair, plication repair, and patch plasty) obtained equivalently appreciable outcomes for cardiac function improvement, perioperative mortality, and survival. Selection of a surgical technique for LVA patients should be optimized to individual patient conditions including the morphological characteristics of the aneurysm and ischemic scar.
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Athanasuleas CL, Stanley AWH, Buckberg GD. Mitral regurgitation: anatomy is destiny. Eur J Cardiothorac Surg 2018; 54:627-634. [PMID: 29718159 DOI: 10.1093/ejcts/ezy174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/18/2018] [Indexed: 11/13/2022] Open
Abstract
Mitral regurgitation (MR) occurs when any of the valve and ventricular mitral apparatus components are disturbed. As MR progresses, left ventricular remodelling occurs, ultimately causing heart failure when the enlarging left ventricle (LV) loses its conical shape and becomes globular. Heart failure and lethal ventricular arrhythmias may develop if the left ventricular end-systolic volume index exceeds 55 ml/m2. These adverse changes persist despite satisfactory correction of the annular component of MR. Our goal was to describe this process and summarize evolving interventions that reduce the volume of the left ventricle and rebuild its elliptical shape. This 'valve/ventricle' approach addresses the spherical ventricular culprit and offsets the limits of treating MR by correcting only its annular component.
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Affiliation(s)
- Constantine L Athanasuleas
- Section of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Gerald D Buckberg
- Department of Cardiothoracic Surgery, University of California Los Angeles, Los Angeles, CA, USA
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