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Surgical Ventricular Restoration for Ischemic Heart Failure: A Glance at a Real-World Population
Serenella Castelvecchio1, Valentina Milani2, Federico Ambrogi2,3
1Department of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Italy.
Insights
Surgical ventricular restoration (SVR) offers a viable treatment for ischemic heart failure (HF). This study found SVR can yield favorable outcomes, particularly in patients with significant left ventricular remodeling and less extensive coronary artery disease (CAD).
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Failure Management
Background:
- Surgical ventricular restoration (SVR) is a proposed treatment for ischemic heart failure (HF).
- The survival benefit of SVR in HF patients remains under investigation.
- Real-world data on SVR outcomes are crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the effectiveness and survival benefit of SVR in a large, real-world cohort of ischemic heart failure patients.
- To compare outcomes between patients operated in different time periods to identify potential improvements or changes in practice.
- To determine if patient characteristics, such as ventricular remodeling and coronary artery disease extent, influence SVR outcomes.
Main Methods:
- Retrospective analysis of 648 patients undergoing SVR between July 2001 and June 2017.
- Patients were divided into two groups based on operation date (Group I: 2001-2007, Group II: 2008-2017).
- Comparison of baseline characteristics, 30-day mortality, and long-term all-cause mortality using Kaplan-Meier estimates.
Main Results:
- Group I patients presented with more angina symptoms and less severe HF symptoms (NYHA class III/IV).
- Group I also had lower end-diastolic and end-systolic volumes, indicating less left ventricular remodeling.
- Despite differences in baseline characteristics, 30-day mortality was similar between groups (6.64%), and long-term survival did not differ significantly (Log-rank = 0.11).
- A trend towards better outcomes was observed in patients with worse LV remodeling and less extensive coronary artery disease (CAD).
Conclusions:
- Surgical ventricular restoration (SVR) can be performed with favorable results in a real-world ischemic heart failure population.
- The procedure appears safe with acceptable short-term mortality.
- SVR may offer a survival advantage in specific patient subgroups, particularly those with more significant left ventricular remodeling and less extensive coronary artery disease.
Abstract:
Surgical ventricular restoration (SVR) has repeatedly been suggested as a viable therapeutic strategy for ischemic heart failure (HF) patients, although the survival benefit is still debated. We investigated a real-world population treated with SVR in a single center with high case volumes. From July 2001 to June 2017, 648 patients (111 females) underwent SVR; coronary surgery was performed in 582 patients. Data were analyzed by dividing the population into two groups: Group I (371 patients operated between July 2001 and December 2007) and Group II (277 patients operated between January 2008 and June 2017). At baseline, Group I patients were more symptomatic for angina (47.4% versus 19.4%, p < 0.0001) and less symptomatic for HF (NYHA class III/IV, 46.3% versus 57%, p = 0.0071). The end-diastolic volume (106 mL/m2 versus 118.3 mL/m2, p < 0.0001) and the end-systolic volume (70.5 mL/m2 versus 81.5 mL/m2, p < 0.0001) were lower in Group I. The presence of 3-vessel coronary artery disease (CAD) was higher in Group I (73.3% versus 59.2%, p < 0.0001). Thirty-day mortality (6.64%) was similar in the two groups (p = 0.4475). The Kaplan−Meier estimate for all-cause mortality for the entire population was 13% at 2 years, 19.2% at 4 years and 36.6% at 8 years, and the probability was not different between groups (Log-rank = 0.11). In a real-world ischemic HF population, SVR may be carried out with favorable results; in patients with worse LV remodeling and less extensive CAD, SVR showed a trend toward a better outcome.
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