Literature DB >> 17662785

Surgical therapy for ischemic heart failure: single-center experience with surgical anterior ventricular restoration.

Lorenzo Menicanti1, Serenella Castelvecchio, Marco Ranucci, Alessandro Frigiola, Carlo Santambrogio, Carlo de Vincentiis, Jelena Brankovic, Marisa Di Donato.   

Abstract

OBJECTIVES: Our objectives were (1) to report operative and long-term mortality in patients submitted to anterior surgical ventricular restoration, (2) to report changes in clinical and cardiac status induced by surgical ventricular restoration, and (3) to report predictors of death in a large cohort of patients operated on at San Donato Hospital, Milan, Italy.
METHODS: A total of 1161 consecutive patients (83% men, 62 +/- 10 years) had anterior surgical ventricular restoration with or without coronary artery bypass grafting and with or without mitral repair/replacement. A complete echocardiographic study was performed in 488 of 1161 patients operated on between January 1998 and October 2005 (study group). The indication for surgery was heart failure in 60% of patients, angina, and/or a combination of the two.
RESULTS: Thirty-day cardiac mortality was 4.7% (55/1161) in the overall group and 4.9% (24/488) in the study group. Determinants of hospital mortality were mitral valve regurgitation and need for a mitral valve repair/replacement. Mitral regurgitation (>2+) associated with a New York Heart Association class greater than II and with diastolic dysfunction (early-to-late diastolic filling pressure >2) further increases mortality risk. Global systolic function improved postoperatively: ejection fraction improved from 33% +/- 9% to 40% +/- 10% (P < .001); end-diastolic and end-systolic volumes decreased from 211 +/- 73 to 142 +/- 50 and 145 +/- 64 to 88 +/- 40 mL, respectively (P < .001) early after surgery. New York Heart Association functional class improved from 2.7 +/- 0.9 to 1.6 +/- 0.7 (P < .001) late after surgery. Long-term survival in the overall population was 63% at 120 months.
CONCLUSIONS: Surgical ventricular restoration for ischemic heart failure reduces ventricular volumes, improves cardiac function and functional status, carries an acceptable operative mortality, and results in good long-term survival. Predictors of operative mortality are mitral regurgitation of 2+ or more, New York Heart Association class greater than II, and diastolic dysfunction (early-to-late diastolic filling pressure >2).

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Year:  2007        PMID: 17662785     DOI: 10.1016/j.jtcvs.2006.12.027

Source DB:  PubMed          Journal:  J Thorac Cardiovasc Surg        ISSN: 0022-5223            Impact factor:   5.209


  36 in total

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8.  Mid-term results of mitral valve repair for ischemic mitral regurgitation adjusted according to the degree of remodeling progression.

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9.  Surgical ventricular restoration to reverse left ventricular remodeling.

Authors:  Serenella Castelvecchio; Lorenzo Menicanti; Marisa Di Donato
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10.  Surgical Ventricular Restoration: An Operation to Reverse Remodeling - Clinical Application (Part II).

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