title: The impact of volume reduction on early and long-term outcomes in surgical ventricular restoration for severe heart failure.
abstract: BACKGROUND
  Recent published results suggest no additive benefit to surgical ventricular restoration (SVR) when combined with coronary artery bypass grafting. However, there may still be a subgroup of patients with severe heart failure who can benefit from this procedure. We reviewed our institutional experience with SVR to determine early and late outcomes based on volume reduction.
  
  
  METHODS
  We retrospectively reviewed our SVR patients (January 2002 to April 2008) with follow-up to March 2009. Baseline comorbidities, operative data, and postoperative outcomes were assessed by chart review, phone calls, and mailings. Survival was modeled using the Kaplan-Meier method. Cardiac magnetic resonance imaging, myocardial perfusion scans, and echocardiography assessed cardiac function, candidacy for SVR, and volume reduction.
  
  
  RESULTS
  We reviewed 87 consecutive SVR patients (69 men). Mean age at operation was 61.1 years. Preoperatively, all patients had congestive heart failure, with 80 (92%) at New York Heart Association III/IV. All patients underwent preoperative viability studies. Three-vessel occlusion exceeding 50% was present in 69 (79%). After SVR, ejection fraction improved from 0.236 to 0.332 (p<0.001). Preoperative and postoperative magnetic resonance imaging in 26 patients (30.0%) showed a 30.8% reduction in left ventricular end systolic volume index. At follow-up, 51 of 66 (77%) improved to New York Heart Association I/II. One intraoperative death occurred. Preoperative left ventricular end systolic volume index of 80 to 120 was associated with improved survival (73% at 3 years).
  
  
  CONCLUSIONS
  SVR is a surgical option for appropriately selected patients with severe congestive heart failure. In these high-risk patients, SVR successfully increased ejection fraction and decreased symptoms. A left ventricular end systolic volume index of 80 to 120 may be the ideal range for SVR procedures.
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, The Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
authors.forename: Nathan Wm
authors.initials: NW
authors.lastname: Skelley
authors.forename: Jeremiah G
authors.initials: JG
authors.lastname: Allen
authors.forename: George J
authors.initials: GJ
authors.lastname: Arnaoutakis
authors.forename: Eric S
authors.initials: ES
authors.lastname: Weiss
authors.forename: Nishant D
authors.initials: ND
authors.lastname: Patel
authors.forename: John V
authors.initials: JV
authors.lastname: Conte
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013318:Stroke Volume; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome