TY - JOUR
T1 - Surgical ventricular restoration for patients with ischemic heart failure
T2 - Determinants of two-year survival
AU - Witkowski, Tomasz G.
AU - Ten Brinke, Ellen A.
AU - Delgado, Victoria
AU - Ng, Arnold C.T.
AU - Bertini, Matteo
AU - Marsan, Nina Ajmone
AU - Ewe, See H.
AU - Auger, Dominique
AU - Yiu, Kelvin H.
AU - Braun, Jerry
AU - Klein, Patrick
AU - Steendijk, Paul
AU - Versteegh, Michel I.M.
AU - Klautz, Robert J.
AU - Bax, Jeroen J.
PY - 2011/2
Y1 - 2011/2
N2 - Background Surgical ventricular restoration (SVR) improves left ventricular (LV) systolic function by partially restoring the normal geometry of the left ventricle. However, the beneficial effects of this surgical procedure on long-term clinical outcome remain controversial. The present study aimed to evaluate the independent determinants of 2-year morbidity and mortality rates after SVR. Methods Seventy-nine patients with ischemic heart disease and LV ejection fraction of 0.35 or less were included. All patients underwent SVR and additionally coronary artery bypass grafting or mitral valve surgery if clinically indicated. Clinical and echocardiographic examination was performed before SVR and at 6 months' follow-up. The primary end point was a composite of all-cause mortality and hospitalizations for heart failure. Results At 6 months' follow-up a significant improvement in heart failure symptoms was noted. In addition, LV ejection fraction increased from 0.27 ± 0.07 to 0.36 ± 0.10 (p < 0.001). During a median follow-up of 2.7 years, the primary end point was recorded in 22% of the patients. Baseline New York Heart Association functional class IV and a 6-month follow-up LV end-systolic volume index of at least 60 mL/m2 were independently associated with worse outcome (hazard ratio, 5.4; 95% confidence interval, 1.9 to 15.2; p < 0.001; hazard ratio, 2.7; 95% confidence interval, 1.3 to 5.6; p < 0.001, respectively). Conclusions Advanced heart failure status at baseline and large residual postsurgery LV end-systolic volume index were independently associated with increased mortality and heart failure hospitalization rates at 2 years' follow-up after SVR.
AB - Background Surgical ventricular restoration (SVR) improves left ventricular (LV) systolic function by partially restoring the normal geometry of the left ventricle. However, the beneficial effects of this surgical procedure on long-term clinical outcome remain controversial. The present study aimed to evaluate the independent determinants of 2-year morbidity and mortality rates after SVR. Methods Seventy-nine patients with ischemic heart disease and LV ejection fraction of 0.35 or less were included. All patients underwent SVR and additionally coronary artery bypass grafting or mitral valve surgery if clinically indicated. Clinical and echocardiographic examination was performed before SVR and at 6 months' follow-up. The primary end point was a composite of all-cause mortality and hospitalizations for heart failure. Results At 6 months' follow-up a significant improvement in heart failure symptoms was noted. In addition, LV ejection fraction increased from 0.27 ± 0.07 to 0.36 ± 0.10 (p < 0.001). During a median follow-up of 2.7 years, the primary end point was recorded in 22% of the patients. Baseline New York Heart Association functional class IV and a 6-month follow-up LV end-systolic volume index of at least 60 mL/m2 were independently associated with worse outcome (hazard ratio, 5.4; 95% confidence interval, 1.9 to 15.2; p < 0.001; hazard ratio, 2.7; 95% confidence interval, 1.3 to 5.6; p < 0.001, respectively). Conclusions Advanced heart failure status at baseline and large residual postsurgery LV end-systolic volume index were independently associated with increased mortality and heart failure hospitalization rates at 2 years' follow-up after SVR.
UR - http://www.scopus.com/inward/record.url?scp=78751671151&partnerID=8YFLogxK
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=78751671151&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/21256300
U2 - https://doi.org/10.1016/j.athoracsur.2010.09.074
DO - https://doi.org/10.1016/j.athoracsur.2010.09.074
M3 - Article
C2 - 21256300
SN - 0003-4975
VL - 91
SP - 491
EP - 498
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 2
ER -