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Published on: April 8, 2013
Surgical therapy for ischemic heart failure: single-center experience with surgical anterior ventricular restoration
Lorenzo Menicanti1, Serenella Castelvecchio, Marco Ranucci
1Cardiac Surgery Department, San Donato Hospital, Milano, Italy.
Insights
Surgical ventricular restoration improves heart function and survival for patients with ischemic heart failure. Key predictors of operative mortality include mitral regurgitation and heart failure severity.
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Failure Management
Background:
- Ischemic heart failure often leads to ventricular remodeling and reduced cardiac function.
- Surgical ventricular restoration (SVR) is a procedure aimed at improving cardiac performance in these patients.
Purpose of the Study:
- To evaluate operative and long-term mortality after anterior SVR.
- To assess changes in clinical and cardiac status post-SVR.
- To identify predictors of death in a large SVR cohort.
Main Methods:
- 1161 patients underwent anterior SVR (with or without CABG/mitral repair) between 1998-2005.
- Echocardiography was performed in 488 patients.
- Indications included heart failure, angina, or both.
Main Results:
- 30-day mortality was 4.7% overall and 4.9% in the echocardiography group.
- Mitral regurgitation and need for mitral valve repair/replacement predicted hospital mortality.
- Ejection fraction improved (33% to 40%), volumes decreased, and NYHA class improved (2.7 to 1.6).
- Long-term survival was 63% at 120 months.
Conclusions:
- Anterior SVR effectively reduces ventricular volumes and improves cardiac function and functional status in ischemic heart failure.
- The procedure has acceptable operative mortality and good long-term survival.
- Significant mitral regurgitation, advanced NYHA class, and diastolic dysfunction are predictors of operative mortality.
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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