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Reduction in Left Ventricular Wall Stress and Improvement in Function in Failing Hearts using Algisyl-LVR
Published on: April 8, 2013
Long-term results of left ventricular reconstructive surgery in patients with ischemic dilated cardiomyopathy: a
Koji Takeda1, Goro Matsumiya, Taichi Sakaguchi
1Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Insights
Left ventricular restoration (LVR) improves heart failure after myocardial infarction. This surgery offers long-term survival benefits by restoring heart function and reducing ventricle size.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Left ventricular restoration (LVR) is a growing treatment for chronic heart failure post-myocardial infarction.
- Evaluating the long-term effectiveness and constraints of LVR is crucial.
Purpose of the Study:
- To assess the long-term efficacy and limitations of Left Ventricular Restoration (LVR).
Main Methods:
- Retrospective analysis of 72 patients undergoing LVR between 1999 and 2007.
- Inclusion of concomitant procedures like coronary artery bypass grafting and mitral valve surgery.
- Assessment of preoperative and postoperative cardiac function, including ejection fraction and ventricular volumes.
Main Results:
- Low 30-day mortality (2.8%) and significant improvements in ejection fraction (25% to 39%) and reduced ventricular volumes.
- High actuarial survival rates: 95.3% at 1 year, 80.4% at 3 years, and 71.0% at 5 years.
- 90% of survivors improved to NYHA functional class I or II post-LVR.
Conclusions:
- Left ventricular restoration (LVR) is associated with low operative mortality.
- LVR provides satisfactory long-term survival and functional improvement in heart failure patients.
- The procedure effectively restores the dilated left ventricle and enhances systolic function.
Background:
Left ventricular restoration (LVR) is increasingly used for treatment of chronic heart failure following myocardial infarction. The present multi-institutional retrospective study analyzed the long-term efficacy and limitations of LVR.
Methods And Results:
Seventy-two (58 males, mean age 62+/-10) patients who underwent LVR between January 1999 and June 2007 were included. Preoperatively, 50 (68.5%) were in New York Heart Association (NYHA) functional class III or IV. Mean left ventricular end-diastolic and end-systolic volume indexes were 145+/-43 ml/m(2) and 111+/-40 ml/m(2), respectively, and ejection fraction was 25+/-7.4%. Other concomitant operative procedures included coronary artery bypass grafting in 55 (76.4%), and mitral valve procedures in 38 (52.8%). Thirty-day mortality was 2.8%. Actuarial survival at 1, 3, and 5 years was 95.3%, 80.45 and 71.0% respectively. Mean ejection fraction significantly improved to 39+/-11%, and left ventricular volumes were significantly reduced in the early postoperative period. During a mean of 3.3+/-2.4 years of follow up, these improvements were still significant in the late period. Of the survivors, 90% were in NYHA functional class I or II.
Conclusion:
LVR can be performed with a low operative mortality and provide satisfactory long-term survival by restoring the dilated left ventricle and improving systolic function.
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