BACKGROUND: Optimal treatment strategies for some patients with ischemic cardiomyopathy can be unclear. We compared the outcome for patients treated with revascularization only or with additional ventricular reconstruction. METHODS AND RESULTS: We compared 74 consecutive patients with an ejection fraction <35% and a left end-systolic volume index >80 mL/m(2). All patients underwent revasularization but some received only revascularization (group 1) and some were randomized into a group that received additional ventricular reconstruction (group 2). Preoperative and postoperative ejection fraction, end-systolic volume, mitral regurgitation, mortality, heart failure (HF) symptoms, and recurrence were compared between groups. There was 1 postoperative death in group 2 (P =. 58). Preoperative ejection fraction between the groups was similar (P =. 19) but it differed significantly postoperatively (P < .001). HF class (New York Heart Association) decreased more in group 2 (group 2, 2.3 +/- 0.4 versus group 1, 1.4 +/- 0.4; P < .001). Incidence of HF recurrence and rehospitalization was significantly less in group 2 (P = .028). The postoperative development of higher-grade mitral regurgitation was greater in group 1 (147 +/- 32 mL/m(2) versus 119 +/- 25 mL/m(2), P = .024). CONCLUSION: The outcome at midterm of coronary artery surgery alone in patients with a preoperative large left ventricle was inferior compared with the outcome achieved with additional ventricular restoration.
RCT Entities:
BACKGROUND: Optimal treatment strategies for some patients with ischemic cardiomyopathy can be unclear. We compared the outcome for patients treated with revascularization only or with additional ventricular reconstruction. METHODS AND RESULTS: We compared 74 consecutive patients with an ejection fraction <35% and a left end-systolic volume index >80 mL/m(2). All patients underwent revasularization but some received only revascularization (group 1) and some were randomized into a group that received additional ventricular reconstruction (group 2). Preoperative and postoperative ejection fraction, end-systolic volume, mitral regurgitation, mortality, heart failure (HF) symptoms, and recurrence were compared between groups. There was 1 postoperative death in group 2 (P =. 58). Preoperative ejection fraction between the groups was similar (P =. 19) but it differed significantly postoperatively (P < .001). HF class (New York Heart Association) decreased more in group 2 (group 2, 2.3 +/- 0.4 versus group 1, 1.4 +/- 0.4; P < .001). Incidence of HF recurrence and rehospitalization was significantly less in group 2 (P = .028). The postoperative development of higher-grade mitral regurgitation was greater in group 1 (147 +/- 32 mL/m(2) versus 119 +/- 25 mL/m(2), P = .024). CONCLUSION: The outcome at midterm of coronary artery surgery alone in patients with a preoperative large left ventricle was inferior compared with the outcome achieved with additional ventricular restoration.
Authors: Peng Zhang; Julius M Guccione; Susan I Nicholas; Joseph C Walker; Philip C Crawford; Amin Shamal; Gabriel Acevedo-Bolton; Michael A Guttman; Cengizhan Ozturk; Elliot R McVeigh; David A Saloner; Arthur W Wallace; Mark B Ratcliffe Journal: J Thorac Cardiovasc Surg Date: 2007-10 Impact factor: 5.209
Authors: Kay Sun; Zhihong Zhang; Takamaro Suzuki; Jonathan F Wenk; Nielen Stander; Daniel R Einstein; David A Saloner; Arthur W Wallace; Julius M Guccione; Mark B Ratcliffe Journal: J Thorac Cardiovasc Surg Date: 2010-03-17 Impact factor: 5.209
Authors: Jan Naar; Ivo Skalský; Andreas Krűger; Filip Málek; Kevin Van Bladel; Lon S Annest; Petr Moučka; Tomáš Mráz; Vivek Y Reddy; Petr Neužil Journal: J Cardiovasc Transl Res Date: 2021-05-11 Impact factor: 4.132