Clinical efficacy of surgical heart failure therapy by ventricular restoration and restrictive mitral annuloplasty.
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.


RESULTS
Thirty-three patients (New York Heart Association (NYHA) class III/IV, left ventricular ejection fraction < or =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/m(2) (P < .001) and end-systolic volume decreased from 78 +/- 32 to 53 +/- 15 mL/m(2) (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.
Tulner
Sven A
SA
Departments of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Steendijk
Paul
P
Klautz
Robert J
RJ
Tops
Laurens
L
Bax
Jeroen J
JJ
Versteegh
Michel I
MI
Verwey
Harriette F
HF
Schalij
Martin J
MJ
van der Wall
Ernst E
EE
Dion
Robert A
RA
D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left