Surgical ventricular remodeling for patients with clinically advanced congestive heart failure and severe left ventricular dysfunction

Nishant D. Patel, Christopher J. Barreiro, Jason A. Williams, Pramod N. Bonde, Michele Waldron, Shunsuke Natori, David A. Bluemke, John V. Conte

Research output: Contribution to journalArticle

Abstract

Background: Surgical ventricular remodeling (SVR) is an accepted therapy for post-infarction ventricular remodeling. Current literature on SVR outcomes has focused on heterogeneous populations with regard to left ventricular function and New York Heart Association (NYHA) class. We assessed outcomes after SVR in patients with advanced congestive heart failure (CHF) (NYHA Class III/IV) and a pre-operative ejection fraction (EF) ≤20%. Methods: Data were analyzed for 51 consecutive SVR patients from January 2002 to June 2004. Cardiac catheterization, echocardiography and magnetic resonance imaging (MRI) identified 62.7% (32 of 51) of patients with an EF ≤20%, with the majority having an EF ≤15% (65.6%; 21 of 32). Cox regression analysis was performed to determine predictors of mortality in patients with an EF ≤20%. Follow-up was 100% (32 of 32) complete. Results: Mean age was 61.9 ± 10.3 (range 40 to 80) years with a male:female ratio of 27:5. Operative mortality was 6.3% (2 of 32). Twenty-two percent (7 of 32) had concomitant mitral valve procedures. Follow-up demonstrated a statistically significant improvement in left ventricular volumes and EF in survivors. Cox regression analysis identified the following to be significant predictors of mortality: pre-operative left ventricular end-systolic volume index >130 ml/m2; pre-operative diabetes; and intra-aortic balloon pump usage. Pre-operatively, all patients (32 of 32) were categorized as NYHA Class III/IV, with 69% (22 of 32) improving to NYHA Class I/II at follow-up (p <0.01). Survival did not differ statistically between patients with an EF ≤20% and an EF >20% (n = 19). Conclusions: Our results indicate that SVR improves left ventricular function and functional status for patients with advanced CHF and a pre-operative EF ≤20%. Therefore, SVR is a viable surgical alternative for patients with severe left ventricular dysfunction.

Original languageEnglish (US)
Pages (from-to)2202-2210
Number of pages9
JournalJournal of Heart and Lung Transplantation
Volume24
Issue number12
DOIs
StatePublished - Dec 2005

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Ventricular Remodeling
Left Ventricular Dysfunction
Heart Failure
Left Ventricular Function
Stroke Volume
Mortality
Regression Analysis
Cardiac Catheterization
Mitral Valve
Infarction
Survivors
Echocardiography
Magnetic Resonance Imaging
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

Surgical ventricular remodeling for patients with clinically advanced congestive heart failure and severe left ventricular dysfunction. / Patel, Nishant D.; Barreiro, Christopher J.; Williams, Jason A.; Bonde, Pramod N.; Waldron, Michele; Natori, Shunsuke; Bluemke, David A.; Conte, John V.

In: Journal of Heart and Lung Transplantation, Vol. 24, No. 12, 12.2005, p. 2202-2210.

Research output: Contribution to journalArticle

Patel, Nishant D. ; Barreiro, Christopher J. ; Williams, Jason A. ; Bonde, Pramod N. ; Waldron, Michele ; Natori, Shunsuke ; Bluemke, David A. ; Conte, John V. / Surgical ventricular remodeling for patients with clinically advanced congestive heart failure and severe left ventricular dysfunction. In: Journal of Heart and Lung Transplantation. 2005 ; Vol. 24, No. 12. pp. 2202-2210.
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abstract = "Background: Surgical ventricular remodeling (SVR) is an accepted therapy for post-infarction ventricular remodeling. Current literature on SVR outcomes has focused on heterogeneous populations with regard to left ventricular function and New York Heart Association (NYHA) class. We assessed outcomes after SVR in patients with advanced congestive heart failure (CHF) (NYHA Class III/IV) and a pre-operative ejection fraction (EF) ≤20{\%}. Methods: Data were analyzed for 51 consecutive SVR patients from January 2002 to June 2004. Cardiac catheterization, echocardiography and magnetic resonance imaging (MRI) identified 62.7{\%} (32 of 51) of patients with an EF ≤20{\%}, with the majority having an EF ≤15{\%} (65.6{\%}; 21 of 32). Cox regression analysis was performed to determine predictors of mortality in patients with an EF ≤20{\%}. Follow-up was 100{\%} (32 of 32) complete. Results: Mean age was 61.9 ± 10.3 (range 40 to 80) years with a male:female ratio of 27:5. Operative mortality was 6.3{\%} (2 of 32). Twenty-two percent (7 of 32) had concomitant mitral valve procedures. Follow-up demonstrated a statistically significant improvement in left ventricular volumes and EF in survivors. Cox regression analysis identified the following to be significant predictors of mortality: pre-operative left ventricular end-systolic volume index >130 ml/m2; pre-operative diabetes; and intra-aortic balloon pump usage. Pre-operatively, all patients (32 of 32) were categorized as NYHA Class III/IV, with 69{\%} (22 of 32) improving to NYHA Class I/II at follow-up (p <0.01). Survival did not differ statistically between patients with an EF ≤20{\%} and an EF >20{\%} (n = 19). Conclusions: Our results indicate that SVR improves left ventricular function and functional status for patients with advanced CHF and a pre-operative EF ≤20{\%}. Therefore, SVR is a viable surgical alternative for patients with severe left ventricular dysfunction.",
author = "Patel, {Nishant D.} and Barreiro, {Christopher J.} and Williams, {Jason A.} and Bonde, {Pramod N.} and Michele Waldron and Shunsuke Natori and Bluemke, {David A.} and Conte, {John V.}",
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T1 - Surgical ventricular remodeling for patients with clinically advanced congestive heart failure and severe left ventricular dysfunction

AU - Patel, Nishant D.

AU - Barreiro, Christopher J.

AU - Williams, Jason A.

AU - Bonde, Pramod N.

AU - Waldron, Michele

AU - Natori, Shunsuke

AU - Bluemke, David A.

AU - Conte, John V.

PY - 2005/12

Y1 - 2005/12

N2 - Background: Surgical ventricular remodeling (SVR) is an accepted therapy for post-infarction ventricular remodeling. Current literature on SVR outcomes has focused on heterogeneous populations with regard to left ventricular function and New York Heart Association (NYHA) class. We assessed outcomes after SVR in patients with advanced congestive heart failure (CHF) (NYHA Class III/IV) and a pre-operative ejection fraction (EF) ≤20%. Methods: Data were analyzed for 51 consecutive SVR patients from January 2002 to June 2004. Cardiac catheterization, echocardiography and magnetic resonance imaging (MRI) identified 62.7% (32 of 51) of patients with an EF ≤20%, with the majority having an EF ≤15% (65.6%; 21 of 32). Cox regression analysis was performed to determine predictors of mortality in patients with an EF ≤20%. Follow-up was 100% (32 of 32) complete. Results: Mean age was 61.9 ± 10.3 (range 40 to 80) years with a male:female ratio of 27:5. Operative mortality was 6.3% (2 of 32). Twenty-two percent (7 of 32) had concomitant mitral valve procedures. Follow-up demonstrated a statistically significant improvement in left ventricular volumes and EF in survivors. Cox regression analysis identified the following to be significant predictors of mortality: pre-operative left ventricular end-systolic volume index >130 ml/m2; pre-operative diabetes; and intra-aortic balloon pump usage. Pre-operatively, all patients (32 of 32) were categorized as NYHA Class III/IV, with 69% (22 of 32) improving to NYHA Class I/II at follow-up (p <0.01). Survival did not differ statistically between patients with an EF ≤20% and an EF >20% (n = 19). Conclusions: Our results indicate that SVR improves left ventricular function and functional status for patients with advanced CHF and a pre-operative EF ≤20%. Therefore, SVR is a viable surgical alternative for patients with severe left ventricular dysfunction.

AB - Background: Surgical ventricular remodeling (SVR) is an accepted therapy for post-infarction ventricular remodeling. Current literature on SVR outcomes has focused on heterogeneous populations with regard to left ventricular function and New York Heart Association (NYHA) class. We assessed outcomes after SVR in patients with advanced congestive heart failure (CHF) (NYHA Class III/IV) and a pre-operative ejection fraction (EF) ≤20%. Methods: Data were analyzed for 51 consecutive SVR patients from January 2002 to June 2004. Cardiac catheterization, echocardiography and magnetic resonance imaging (MRI) identified 62.7% (32 of 51) of patients with an EF ≤20%, with the majority having an EF ≤15% (65.6%; 21 of 32). Cox regression analysis was performed to determine predictors of mortality in patients with an EF ≤20%. Follow-up was 100% (32 of 32) complete. Results: Mean age was 61.9 ± 10.3 (range 40 to 80) years with a male:female ratio of 27:5. Operative mortality was 6.3% (2 of 32). Twenty-two percent (7 of 32) had concomitant mitral valve procedures. Follow-up demonstrated a statistically significant improvement in left ventricular volumes and EF in survivors. Cox regression analysis identified the following to be significant predictors of mortality: pre-operative left ventricular end-systolic volume index >130 ml/m2; pre-operative diabetes; and intra-aortic balloon pump usage. Pre-operatively, all patients (32 of 32) were categorized as NYHA Class III/IV, with 69% (22 of 32) improving to NYHA Class I/II at follow-up (p <0.01). Survival did not differ statistically between patients with an EF ≤20% and an EF >20% (n = 19). Conclusions: Our results indicate that SVR improves left ventricular function and functional status for patients with advanced CHF and a pre-operative EF ≤20%. Therefore, SVR is a viable surgical alternative for patients with severe left ventricular dysfunction.

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