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[Ischemic heart disease complicated by heart failure: possibilities of surgical treatment]

D V Kuznetsov, S M Khokhlunov, A P Semagin

    Kardiologiia
    |August 20, 2013
    PubMed

    Insights

    Surgical reconstruction of the left ventricle (LV) in patients with ischemic heart disease (IHD) and chronic heart failure (CHF) improved survival and reduced heart failure symptoms. This procedure offers satisfactory long-term outcomes for IHD patients with LV issues.

    Area of Science:

    • Cardiology
    • Cardiac Surgery
    • Heart Failure Research

    Background:

    • Ischemic heart disease (IHD) frequently leads to chronic heart failure (CHF) and left ventricular (LV) dysfunction.
    • LV aneurysms and ischemic cardiomyopathy are significant complications of IHD, impacting patient prognosis.
    • Surgical intervention is considered for advanced stages of IHD with heart failure.

    Purpose of the Study:

    • To evaluate the long-term outcomes of surgical left ventricular reconstruction in patients suffering from ischemic heart disease and chronic heart failure.
    • To assess the impact of combined coronary bypass surgery and Dor LV reconstruction on cardiac function and survival rates.

    Main Methods:

    • A cohort of 136 patients with IHD and CHF underwent coronary bypass surgery and Dor LV reconstruction between 1996 and 2010.
    • Patients were stratified into two groups: those with LV aneurysms (Group 1) and those with ischemic cardiomyopathy (Group 2).
    • Mitral regurgitation was addressed surgically when moderate to severe.

    Main Results:

    • Hospital mortality was 5.4% in the ischemic cardiomyopathy group, with no in-hospital deaths in the LV aneurysm group.
    • Survivors demonstrated reduced LV dimensions, improved LV cavity sphericity, and increased LV ejection fraction.
    • Ten-year survival rates were 78% for Group 1 and 56.5% for Group 2.
    • At 10 years post-surgery, 80.2% of Group 1 and 68% of Group 2 patients were free from high-grade (NYHA Class III-IV) CHF symptoms.

    Conclusions:

    • Surgical intervention addressing intracardiac pathology in IHD patients with CHF yields favorable long-term results.
    • Combined coronary bypass surgery and Dor LV reconstruction significantly improve cardiac function, survival, and quality of life.
    • This approach is effective in managing complex cardiac conditions arising from ischemic heart disease.

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