Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation.
OBJECTIVE
The purpose of this study was to test how surgical ventricular restoration (SVR) affects early and late survival in a registry of 1,198 post-anterior infarction congestive heart failure (CHF) patients treated by the international Reconstructive Endoventricular Surgery returning Torsion Original Radius Elliptical shape to the left ventricle (RESTORE)team.


BACKGROUND
Congestive heart failure may be caused by late left ventricular (LV) dilation after anterior infarction. The infarcted segment is often akinetic rather than dyskinetic because early reperfusion prevents transmural necrosis. Previously, only dyskinetic areas were treated by operation. Surgical ventricular restoration reduces LV volume and creates a more elliptical chamber by excluding scar in either akinetic or dyskinetic segments.


METHODS
The RESTORE group applied SVR to 1,198 post-infarction patients between 1998 and 2003. Early and late outcomes were examined, and risk factors were identified.


RESULTS
Concomitant procedures included coronary artery bypass grafting in 95%, mitral valve repair in 22%, and mitral valve replacement in 1%. Overall 30-day mortality after SVR was 5.3% (8.7% with mitral repair vs. 4.0% without repair; p < 0.001). Perioperative mechanical support was uncommon (<9%). Global systolic function improved postoperatively. Ejection fraction (EF) increased from 29.6 +/- 11.0% preoperatively to 39.5 +/- 12.3% postoperatively (p < 0.001). The left ventricular end-systolic volume index (LVESVI) decreased from 80.4 +/- 51.4 ml/m(2) preoperatively to 56.6 +/- 34.3 ml/m(2) postoperatively (p < 0.001). Overall five-year survival was 68.6 +/- 2.8%. Logistic regression analysis identified EF <or=30%, LVESVI >or=80 ml/m(2), advanced New York Heart Association (NYHA) functional class, and age >or=75 years as risk factors for death. Five-year freedom from hospital readmission for CHF was 78%. Preoperatively, 67% of patients were NYHA functional class III or IV and postoperatively, 85% were class I or II.


CONCLUSIONS
Surgical ventricular restoration improves ventricular function and is highly effective therapy in the treatment of ischemic cardiomyopathy with excellent five-year outcome.
Athanasuleas
Constantine L
CL
Norwood Clinic and Kemp Carraway Heart Institute, Birmingham, Alabama, USA.
Buckberg
Gerald D
GD
Stanley
Alfred W H
AW
Siler
William
W
Dor
Vincent
V
Di Donato
Marisa
M
Menicanti
Lorenzo
L
Almeida de Oliveira
Sergio
S
Beyersdorf
Friedhelm
F
Kron
Irving L
IL
Suma
Hisayoshi
H
Kouchoukos
Nicholas T
NT
Moore
Wistar
W
McCarthy
Patrick M
PM
Oz
Mehmet C
MC
Fontan
Francis
F
Scott
Meredith L
ML
Accola
Kevin A
KA
D000368:Aged; D001794:Blood Pressure; D001026:Coronary Artery Bypass; D004108:Dilatation, Pathologic / Q000150:complications / Q000209:etiology / Q000601:surgery; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006352:Heart Ventricles / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D009203:Myocardial Infarction / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D012720:Severity of Illness Index; D013318:Stroke Volume; D016896:Treatment Outcome