TY - JOUR
T1 - Clinical Efficacy of Surgical Heart Failure Therapy by Ventricular Restoration and Restrictive Mitral Annuloplasty
AU - Tulner, Sven A.
AU - Steendijk, Paul
AU - Klautz, Robert J.
AU - Tops, Laurens
AU - Bax, Jeroen J.
AU - Versteegh, Michel I.
AU - Verwey, Harriette F.
AU - Schalij, Martin J.
AU - van der Wall, Ernst E.
AU - Dion, Robert A.
PY - 2007
Y1 - 2007
N2 - Background: Treatment of heart failure by advanced surgical procedures such as ventricular restoration (SVR) and restrictive mitral annuloplasty (RMA) is increasingly applied. We studied clinical efficacy of heart failure surgery in patients with severe heart failure. Methods and Results: Thirty-three patients (New York Heart Association (NYHA) class III/IV, left ventricular ejection fraction ≤35%) were included. Patients with moderate to severe mitral regurgitation underwent RMA (85%) and patients with anteroseptal aneurysm underwent SVR (52%). A combined procedure was performed in 12 patients, and additional coronary artery bypass grafting in 27 patients. Clinical and echocardiographic parameters were assessed at baseline and 6 months after surgery. Operative mortality was 3% (n = 1), in-hospital mortality was 9% (n = 3), and there was no late mortality. All clinical parameters were significantly improved at 6 months' follow-up (P < .001); NYHA class improved from 3.4 ± 0.5 to 1.5 ± 0.5, Quality-of-life score improved from 44 ± 22 to 16 ± 12, and 6-minute walking distance increased from 248 ± 134 m to 422 ± 113 m. Left ventricular end-diastolic volume decreased from 107 ± 32 to 80 ± 20 mL/m2 (P < .001) and end-systolic volume decreased from 78 ± 32 to 53 ± 15 mL/m2 (P < .001), whereas ejection fraction improved from 29 ± 9 to 35 ± 7% (P < .01). Conclusions: Surgical treatment of severe heart failure by SVR or RMA was associated with 12% mortality at 6 months. Surviving patients showed highly significant functional and clinical improvements. © 2007 Elsevier Inc. All rights reserved.
AB - Background: Treatment of heart failure by advanced surgical procedures such as ventricular restoration (SVR) and restrictive mitral annuloplasty (RMA) is increasingly applied. We studied clinical efficacy of heart failure surgery in patients with severe heart failure. Methods and Results: Thirty-three patients (New York Heart Association (NYHA) class III/IV, left ventricular ejection fraction ≤35%) were included. Patients with moderate to severe mitral regurgitation underwent RMA (85%) and patients with anteroseptal aneurysm underwent SVR (52%). A combined procedure was performed in 12 patients, and additional coronary artery bypass grafting in 27 patients. Clinical and echocardiographic parameters were assessed at baseline and 6 months after surgery. Operative mortality was 3% (n = 1), in-hospital mortality was 9% (n = 3), and there was no late mortality. All clinical parameters were significantly improved at 6 months' follow-up (P < .001); NYHA class improved from 3.4 ± 0.5 to 1.5 ± 0.5, Quality-of-life score improved from 44 ± 22 to 16 ± 12, and 6-minute walking distance increased from 248 ± 134 m to 422 ± 113 m. Left ventricular end-diastolic volume decreased from 107 ± 32 to 80 ± 20 mL/m2 (P < .001) and end-systolic volume decreased from 78 ± 32 to 53 ± 15 mL/m2 (P < .001), whereas ejection fraction improved from 29 ± 9 to 35 ± 7% (P < .01). Conclusions: Surgical treatment of severe heart failure by SVR or RMA was associated with 12% mortality at 6 months. Surviving patients showed highly significant functional and clinical improvements. © 2007 Elsevier Inc. All rights reserved.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=34247158998&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/17448414
U2 - https://doi.org/10.1016/j.cardfail.2006.11.010
DO - https://doi.org/10.1016/j.cardfail.2006.11.010
M3 - Article
C2 - 17448414
SN - 1071-9164
VL - 13
SP - 178
EP - 183
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 3
ER -