| Surgical ventricular remodeling for patients with clinically advanced congestive heart failure and severe left ventricular dysfunction. | |
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MedLine Citation:
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PMID: 16364872 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Surgical ventricular remodeling (SVR) is an accepted therapy for post-infarction ventricular remodeling. Current literature on SVR outcomes has focused on heterogeneous populations with regard to left ventricular function and New York Heart Association (NYHA) class. We assessed outcomes after SVR in patients with advanced congestive heart failure (CHF) (NYHA Class III/IV) and a pre-operative ejection fraction (EF) < or =20%. METHODS: Data were analyzed for 51 consecutive SVR patients from January 2002 to June 2004. Cardiac catheterization, echocardiography and magnetic resonance imaging (MRI) identified 62.7% (32 of 51) of patients with an EF < or =20%, with the majority having an EF < or =15% (65.6%; 21 of 32). Cox regression analysis was performed to determine predictors of mortality in patients with an EF < or =20%. Follow-up was 100% (32 of 32) complete. RESULTS: Mean age was 61.9 +/- 10.3 (range 40 to 80) years with a male:female ratio of 27:5. Operative mortality was 6.3% (2 of 32). Twenty-two percent (7 of 32) had concomitant mitral valve procedures. Follow-up demonstrated a statistically significant improvement in left ventricular volumes and EF in survivors. Cox regression analysis identified the following to be significant predictors of mortality: pre-operative left ventricular end-systolic volume index >130 ml/m2; pre-operative diabetes; and intra-aortic balloon pump usage. Pre-operatively, all patients (32 of 32) were categorized as NYHA Class III/IV, with 69% (22 of 32) improving to NYHA Class I/II at follow-up (p < 0.01). Survival did not differ statistically between patients with an EF < or =20% and an EF >20% (n = 19). CONCLUSIONS: Our results indicate that SVR improves left ventricular function and functional status for patients with advanced CHF and a pre-operative EF < or =20%. Therefore, SVR is a viable surgical alternative for patients with severe left ventricular dysfunction. |
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Authors:
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Nishant D Patel; Christopher J Barreiro; Jason A Williams; Pramod N Bonde; Michele Waldron; Shunsuke Natori; David A Bluemke; John V Conte |
Publication Detail:
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Type: Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't Date: 2005-09-15 |
Journal Detail:
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Title: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Volume: 24 ISSN: 1557-3117 ISO Abbreviation: J. Heart Lung Transplant. Publication Date: 2005 Dec |
Date Detail:
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Created Date: 2005-12-20 Completed Date: 2006-07-07 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9102703 Medline TA: J Heart Lung Transplant Country: United States |
Other Details:
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Languages: eng Pagination: 2202-10 Citation Subset: IM |
Affiliation:
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Heart and Lung Transplant Division of Cardiac Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Echocardiography Female Heart Catheterization Heart Failure / surgery* Humans Magnetic Resonance Imaging Male Middle Aged Myocardial Infarction / complications Quality of Life Treatment Outcome Ventricular Dysfunction, Left / etiology, surgery* Ventricular Remodeling* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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