title: Durability of epicardial ventricular restoration without ventriculotomy.
abstract: OBJECTIVE
  We previously presented early results employing a technique designed for beating heart, ventricular volume reduction (surgical ventricular restoration, SVR) without ventriculotomy for patients with antero-septal scar and dilated ischaemic cardiomyopathy. Significant volume reduction and clinical improvement were achieved. We now report durability in the first 11 patients available for assessment at 6 and 12 months after operation.
  
  
  METHODS
  After the Ethics Committee approval, 31 symptomatic patients with left ventricular (LV) dilatation and antero-septal scars underwent operation. The scarred lateral LV wall was apposed to the septal scar with serial paired anchors placed through epicardial transmural catheters, excluding non-viable portions of the chamber. Patients were followed at 1, 3, 6 and 12 months postoperatively with echocardiograms. Data are presented for the first 11 patients for whom core lab echocardiographic data were available at 12 months of follow-up.
  
  
  RESULTS
  LV end-systolic index (LVESVI), percent decreases from baseline at 6 and 12 months were 36.2 ± 18.3 (P < 0.001) and 39.6 ± 14.8 (P < 0.001). LV end-diastolic volume index (LVEDVI) percent decreases from baseline at 6 and 12 months were 28.6 ± 18.8 (P < 0.001) at 6 months and 32.2 ± 14.9 (P < 0.005) at 12 months. All comparisons were by one-tailed t-tests using paired data.
  
  
  CONCLUSIONS
  These results demonstrate the persistence of volume reduction employing a technique designed to be used on beating hearts without ventriculotomy or cardiopulmonary bypass. The extent of volume reduction was consistent with results of conventional SVR in experienced centres. These early data validate the further development of technical iterations leading to a clinical study employing a closed chest endovascular platform.
authors.affiliation: Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA 19106, USA. andrew.wechsler@drexelmed.edu
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Wechsler
authors.forename: Jerzy
authors.initials: J
authors.lastname: Sadowski
authors.forename: Boguslaw
authors.initials: B
authors.lastname: Kapelak
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Bartus
authors.forename: Ginteras
authors.initials: G
authors.lastname: Kalinauskas
authors.forename: Kestutis
authors.initials: K
authors.lastname: Rucinskas
authors.forename: Robertas
authors.initials: R
authors.lastname: Samalavicius
authors.forename: Lon
authors.initials: L
authors.lastname: Annest
mesh_terms: D000818:Animals; D002302:Cardiac Output / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D004452:Echocardiography; D006333:Heart Failure; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D017202:Myocardial Ischemia; D012756:Sheep; D053831:Surgical Fixation Devices
keywords: Heart failure; Ischaemic cardiomyopathy; Surgical ventricular reconstruction