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      Ventricular Reconstruction Surgery for Congestive Heart Failure


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      S. Karger AG

      Left ventricular reconstruction, Heart failure, Cardiomyopathy

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          The significant increase in the prevalence of heart failure in the United States has made this disease a major health problem. The continued shortage of donor organs has prevented heart transplantation from becoming an effective solution for the treatment of end-stage heart failure, and as a result, surgical treatments for heart failure have been reexamined. Surgical therapies represent the evolution of conventional operations, such as coronary artery bypass surgery, and the application of the more novel left ventricular (LV) reconstruction operations which address the geometry of the LV, the important component in the failing heart.

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          Most cited references 19

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          Left ventricular volume predicts postoperative course in patients with ischemic cardiomyopathy.

          The left ventricular end-systolic volume index (LVESVI) helps to predict postoperative left ventricular function in patients with ischemic cardiomyopathy. We retrospectively assessed the ability of preoperative variables to predict death and the development of postoperative congestive heart failure in 41 patients with a preoperative ejection fraction of less than 0.30. A preoperative LVESVI of greater than 100 mL/m2 was identified as an independent predictor of death by Cox's proportional hazards model. Diabetes and a preoperative LVESVI of greater than 100 mL/m2 were independent predictive risk factors for the development of postoperative congestive heart failure. Postoperative congestive heart failure developed in 2 of the 23 patients (8.7%) who had a preoperative LVESVI of less than 100 mL/m2 and in 10 of the 16 patients (62.5%) who had a preoperative LVESVI of greater than 100 mL/m2. The actuarial survival rate during follow-up in patients who had a preoperative LVESVI of less than 100 mL/m2 was significantly greater than that in patients who had a preoperative LVESVI of greater than 100 mL/m2. The actuarial rate of freedom from congestive heart failure during the follow-up period also was greater in patients who had a preoperative LVESVI of less than 100 mL/m2. Our results suggest that the preoperative LVESVI predicts the development of postoperative congestive heart failure and the actuarial survival rate in patients with ischemic cardiomyopathy.
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            Partial left ventriculectomy to treat end-stage heart disease.

            It is reasoned that reducing left ventricular diameter (Laplace's law) in patients with dilated cardiomyopathy, will improve ventricular function. Partial left ventriculectomy was performed in 120 patients with end-stage dilated cardiomyopathies of varying causes. Most patients were in New York Heart Association functional class IV. The procedure consisted of removal of a wedge of left ventricular muscle from the apex to the base of the heart. Depending on the distance between the two papillary muscles, the mitral valve apparatus was either preserved, repaired, or replaced with a tissue prosthesis. The 30-day mortality was 22% and the 2-year survival was 55%. Although 10% of surviving patients showed no improvement in New York Heart Association functional class, most of the surviving patients were in either class I (57%) or II (33.3%), and the others were in class III and IV. Partial left ventriculectomy can be used to treat end-stage dilated cardiomyopathy. Further studies and a longer follow-up period are needed to fully assess the effects of this procedure.
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              Early improvement in congestive heart failure after correction of secondary mitral regurgitation in end-stage cardiomyopathy.

              Mitral regurgitation frequently complicates dilated cardiomyopathy, aggravates volume overload of the left ventricle, and contributes to symptoms of congestive heart failure. This study was performed to assess the impact of mitral valve reconstruction in nine consecutive patients with severe mitral regurgitation resulting from end-stage dilated cardiomyopathy. Clinical and echocardiographic follow-up were obtained 17 +/- 5 and 16 +/- 6 weeks after surgery, respectively. There were no operative or early deaths. All patients noted symptomatic improvement postoperatively, and there was a decrease of at least one New York Heart Association functional class (3.9 +/- 0.3 to 1.7 +/- 0.5, p < 0.001). Quantitative echocardiography/Doppler demonstrated a small but significant decrease in left ventricular end-diastolic volume (317 +/- 111 ml to 291 +/- 105 ml, p = 0.04) and increases in ejection fraction (18 +/- 5% to 24 +/- 9%, p = 0.02) and forward cardiac output (3.1 +/- 1.0 to 4.6 +/- 0.8 L/min, p < 0.01) on follow-up. Mitral valve reconstruction for the correction of mitral regurgitation in patients with end-stage dilated cardiomyopathy results in improved symptomatic status on early follow-up accompanied by evidence of improvement in left ventricular performance.

                Author and article information

                S. Karger AG
                February 2004
                27 February 2004
                : 101
                : 1-3
                : 61-71
                Department of Thoracic and Cardiovascular Surgery, George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, Ohio, USA
                75986 Cardiology 2004;101:61–71
                © 2004 S. Karger AG, Basel

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                Page count
                Figures: 8, References: 58, Pages: 11


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