TY - JOUR
T1 - Outcomes Following Surgical Ventricular Restoration for Patients With Clinically Advanced Congestive Heart Failure (New York Heart Association Class IV)
AU - Williams, Jason A.
AU - Weiss, Eric S.
AU - Patel, Nishant D.
AU - Nwakanma, Lois U.
AU - Conte, John V.
N1 - Funding Information:
Supported in part by the Mildred and Carmont Blitz Cardiac Research Fund. Dr. Williams and Dr. Weiss are Irene Piccinini Investigators in Cardiac Surgery. Dr. Nwakanma is a Hugh R. Sharp Cardiac Surgery Research Fellow. Mr. Patel is the 2005 Chase Medical Scholar for Surgical Ventricular Restoration. Dr Conte has received research support from Chase Medical Corporation.
Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2007/8
Y1 - 2007/8
N2 - Background: It has been well documented that survival in patients with advanced congestive heart failure (CHF) receiving medical therapy is worse with advancing stages of disease (New York Heart Association [NYHA] IV versus NYHA III). However, such comparisons are rare in the surgical treatments for CHF. Surgical ventricular restoration (SVR) is an accepted therapy for patients with ischemic cardiomyopathy after anterior wall myocardial infarction. We evaluated the impact of advanced stage of CHF (NYHA IV) on survival after SVR. Methods and Results: A retrospective review was conducted of SVR patients at our institution between January 2002 and December 2005. Seventy-eight patients underwent SVR during the study period; 34 patients were NYHA IV and 44 patients were NYHA II/III before surgery. NYHA IV patients had significantly worse preoperative ejection fraction (EF), left ventricular end systolic volume index (LVESVI), and stroke volume index (SVI). Both groups demonstrated significant improvement in EF and LVESVI after SVR, and there were no differences between the groups with regard to postoperative EF, LVESVI, or SVI. There were 3 operative deaths in each group (P = 1.00). Sixty-five percent (P < .0001) of NYHA IV patients and 82% (P < .0001) of NYHA II/III patients improved to NYHA class I or II at follow-up. NYHA IV patients trended toward reduced Kaplan-Meier survival at 32 months (68% versus 88%, P = .08), although NYHA IV was not a significant predictor of mortality. Conclusions: NYHA IV patients demonstrate similar improvements in cardiac function with acceptable, although decreased, survival after SVR when compared with those with less severe clinical disease. These outcomes are superior to those reported for medical management, indicating that patients with clinically advanced CHF who are appropriate candidates should be considered for SVR irrespective of preoperative NYHA class.
AB - Background: It has been well documented that survival in patients with advanced congestive heart failure (CHF) receiving medical therapy is worse with advancing stages of disease (New York Heart Association [NYHA] IV versus NYHA III). However, such comparisons are rare in the surgical treatments for CHF. Surgical ventricular restoration (SVR) is an accepted therapy for patients with ischemic cardiomyopathy after anterior wall myocardial infarction. We evaluated the impact of advanced stage of CHF (NYHA IV) on survival after SVR. Methods and Results: A retrospective review was conducted of SVR patients at our institution between January 2002 and December 2005. Seventy-eight patients underwent SVR during the study period; 34 patients were NYHA IV and 44 patients were NYHA II/III before surgery. NYHA IV patients had significantly worse preoperative ejection fraction (EF), left ventricular end systolic volume index (LVESVI), and stroke volume index (SVI). Both groups demonstrated significant improvement in EF and LVESVI after SVR, and there were no differences between the groups with regard to postoperative EF, LVESVI, or SVI. There were 3 operative deaths in each group (P = 1.00). Sixty-five percent (P < .0001) of NYHA IV patients and 82% (P < .0001) of NYHA II/III patients improved to NYHA class I or II at follow-up. NYHA IV patients trended toward reduced Kaplan-Meier survival at 32 months (68% versus 88%, P = .08), although NYHA IV was not a significant predictor of mortality. Conclusions: NYHA IV patients demonstrate similar improvements in cardiac function with acceptable, although decreased, survival after SVR when compared with those with less severe clinical disease. These outcomes are superior to those reported for medical management, indicating that patients with clinically advanced CHF who are appropriate candidates should be considered for SVR irrespective of preoperative NYHA class.
KW - Dor procedure
KW - Heart failure surgery
KW - ischemic cardiomyopathy
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U2 - 10.1016/j.cardfail.2007.03.006
DO - 10.1016/j.cardfail.2007.03.006
M3 - Article
C2 - 17675056
AN - SCOPUS:34547531176
SN - 1071-9164
VL - 13
SP - 431
EP - 436
JO - Journal of cardiac failure
JF - Journal of cardiac failure
IS - 6
ER -