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Tytuł pozycji:

Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation.

Tytuł:
Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation.
Autorzy:
Athanasuleas CL; Norwood Clinic and Kemp Carraway Heart Institute, Birmingham, Alabama, USA.
Buckberg GD
Stanley AW
Siler W
Dor V
Di Donato M
Menicanti L
Almeida de Oliveira S
Beyersdorf F
Kron IL
Suma H
Kouchoukos NT
Moore W
McCarthy PM
Oz MC
Fontan F
Scott ML
Accola KA
Corporate Authors:
RESTORE group
Źródło:
Journal of the American College of Cardiology [J Am Coll Cardiol] 2004 Oct 06; Vol. 44 (7), pp. 1439-45.
Typ publikacji:
Journal Article
Język:
English
Imprint Name(s):
Original Publication: [New York, N.Y.] : Elsevier Biomedical, [c1983-
MeSH Terms:
Heart Failure/*physiopathology
Heart Failure/*surgery
Heart Ventricles/*pathology
Heart Ventricles/*surgery
Myocardial Infarction/*complications
Aged ; Blood Pressure ; Coronary Artery Bypass ; Dilatation, Pathologic/complications ; Dilatation, Pathologic/etiology ; Dilatation, Pathologic/surgery ; Female ; Heart Failure/etiology ; Heart Failure/pathology ; Heart Valve Prosthesis ; Heart Ventricles/physiopathology ; Humans ; Male ; Middle Aged ; Mitral Valve/surgery ; Myocardial Infarction/pathology ; Myocardial Infarction/physiopathology ; Severity of Illness Index ; Stroke Volume ; Treatment Outcome
Entry Date(s):
Date Created: 20041007 Date Completed: 20041027 Latest Revision: 20220408
Update Code:
20240104
DOI:
10.1016/j.jacc.2004.07.017
PMID:
15464325
Czasopismo naukowe
Objectives: The purpose of this study was to test how surgical ventricular restoration (SVR) affects early and late survival in a registry of 1,198 post-anterior infarction congestive heart failure (CHF) patients treated by the international Reconstructive Endoventricular Surgery returning Torsion Original Radius Elliptical shape to the left ventricle (RESTORE)team.
Background: Congestive heart failure may be caused by late left ventricular (LV) dilation after anterior infarction. The infarcted segment is often akinetic rather than dyskinetic because early reperfusion prevents transmural necrosis. Previously, only dyskinetic areas were treated by operation. Surgical ventricular restoration reduces LV volume and creates a more elliptical chamber by excluding scar in either akinetic or dyskinetic segments.
Methods: The RESTORE group applied SVR to 1,198 post-infarction patients between 1998 and 2003. Early and late outcomes were examined, and risk factors were identified.
Results: Concomitant procedures included coronary artery bypass grafting in 95%, mitral valve repair in 22%, and mitral valve replacement in 1%. Overall 30-day mortality after SVR was 5.3% (8.7% with mitral repair vs. 4.0% without repair; p < 0.001). Perioperative mechanical support was uncommon (<9%). Global systolic function improved postoperatively. Ejection fraction (EF) increased from 29.6 +/- 11.0% preoperatively to 39.5 +/- 12.3% postoperatively (p < 0.001). The left ventricular end-systolic volume index (LVESVI) decreased from 80.4 +/- 51.4 ml/m(2) preoperatively to 56.6 +/- 34.3 ml/m(2) postoperatively (p < 0.001). Overall five-year survival was 68.6 +/- 2.8%. Logistic regression analysis identified EF or=80 ml/m(2), advanced New York Heart Association (NYHA) functional class, and age >or=75 years as risk factors for death. Five-year freedom from hospital readmission for CHF was 78%. Preoperatively, 67% of patients were NYHA functional class III or IV and postoperatively, 85% were class I or II.
Conclusions: Surgical ventricular restoration improves ventricular function and is highly effective therapy in the treatment of ischemic cardiomyopathy with excellent five-year outcome.
Comment in: J Am Coll Cardiol. 2005 Aug 2;46(3):562; author reply 562-3. (PMID: 16053978)

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