| Volume reduction rate by surgical ventricular restoration determines late outcome in ischaemic cardiomyopathy. | |
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MedLine Citation:
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PMID: 21317149 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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AIMS: Surgical ventricular restoration (SVR) effectively reduces left ventricular (LV) volume in ischaemic cardiomyopathy (ICM), but the recent Surgical Treatment of Ischemic Heart Failure (STICH) Trial questions its importance. We report 8-year SVR experience in patients with ICM. METHODS AND RESULTS: Between 2000 and 2008, 135 patients underwent SVR for ICM. This report analyses data from 90 patients who underwent accurate pre- and post-operative assessment of LV volumes by left ventriculogram or scintigram. All patients also had echocardiograms. Pre-operative LV end-systolic volume index (ESVI) was 123.5 ± 53.2 mL/m(2) (range 92-310). Overall, 63 patients were in NHYA class III and 27 were in class IV. The SVR procedure was endoventricular circular patch plasty in 33 patients, septal-anterior ventricular exclusion in 43, and 14 patients had posterior exclusion. Coronary artery bypass grafting was performed in 78 patients (87%) and 50 underwent mitral procedures. Eighteen follow-up late deaths occurred owing to chronic heart failure (n = 12) and sudden death (n = 6). Post-operative ESVI was <90 mL/m(2) (Group-S) in 54 patients, 90-120 mL/m(2) (Group-M) in 16, and >120 mL/m(2) (Group-L) in 20 patients. The 8-year survival rate was 82.4% in group-S following a >33% LV volume reduction. In contrast, in Group-M and Group-L, the volume reduction was ∼15%, and 100% of patients died within 7 years following the SVR procedure (or 0% 8-year survival). CONCLUSIONS: SVR is most effective when a >33% volume reduction rate achieves an ESVI of <90mL/m(2). No long-term benefits occur when SVR induces an LV volume reduction of <15% leaving a residual ESVI >90 mL/m(2). This database contradicts the STICH trial findings. |
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Authors:
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Tadashi Isomura; Joji Hoshino; Yasuhisa Fukada; Aki Kitamura; Shintaro Katahira; Taichi Kondo; Tomoaki Iwasaki; Gerald Buckberg; |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-2-11 |
Journal Detail:
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Title: European journal of heart failure : journal of the Working Group on Heart Failure of the European Society of Cardiology Volume: - ISSN: 1879-0844 ISO Abbreviation: - Publication Date: 2011 Feb |
Date Detail:
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Created Date: 2011-2-14 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100887595 Medline TA: Eur J Heart Fail Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Division of Cardiovascular Surgery, Hayama Heart Center, Hayama, Japan. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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