Surgical ventricular restoration: the RESTORE Group experience

Area of Science:

• Cardiology
• Cardiac Surgery
• Heart Failure Management

Background:

• Late left ventricular dilation post-infarction can lead to congestive heart failure.
• Early reperfusion limits necrosis but may not prevent ventricular remodeling.
• Surgical ventricular restoration (SVR) aims to reduce left ventricular volume and reshape the heart.

Purpose of the Study:

• To evaluate the early and late outcomes of SVR in post-infarction patients.
• To identify risk factors associated with mortality after SVR.
• To assess the impact of SVR on ventricular function and heart failure symptoms.

Main Methods:

• The RESTORE group analyzed registry data from 1198 patients undergoing SVR between 1998 and 2003.
• Concomitant procedures included coronary artery bypass grafting and mitral valve surgery.
• Outcomes included 30-day mortality, perioperative support, systolic function, long-term survival, and heart failure readmissions.

Main Results:

• 30-day mortality was 5.3%, with higher rates when combined with mitral valve repair (8.7%).
• Postoperative ejection fraction improved significantly (29.6% to 39.5%), and LVESVI decreased (80.4 to 56.6 ml/m²).
• Five-year survival was 68.6%, with risk factors including low EF, high LVESVI, advanced NYHA class, and age ≥75.

Conclusions:

• SVR significantly improves ventricular function and reduces left ventricular volume in ischemic cardiomyopathy.
• The procedure demonstrates excellent 5-year outcomes, with a high rate of functional class improvement.
• SVR is a highly effective therapy for selected post-infarction patients with heart failure.