PMID- 15799916
OWN - NLM
STAT- MEDLINE
DCOM- 20061213
LR  - 20071115
IS  - 1522-6662 (Electronic)
IS  - 1098-3511 (Linking)
VI  - 7
IP  - 5
DP  - 2004
TI  - Surgical ventricular restoration in end-stage ischemic cardiomyopathy patients.
PG  - E420-2
AB  - BACKGROUND: Surgical ventricular restoration (SVR) has generally been 
      contraindicated in patients with an ejection fraction (EF) <20%, with pulmonary 
      arterial (PA) pressure >60 mm Hg, and being treated with inotropic agents. 
      PATIENTS AND METHODS: The patients in this study were 6 men and 5 women 50 to 78 
      years of age (mean, 62.4 years). Three patients were in New York Heart 
      Association (NYHA) class III with an EF <30%. Eight patients were in NYHA class 
      IV with EF <20%, PA pressure >70 mm Hg, and left ventricular asynergy. Three 
      patients had had recent myocardial infarction (MI) with shock and multiple organ 
      failure. Three patients had mitral regurgitation, 1 patient had ventricular 
      septal defect (VSD), 4 patients had diabetes mellitus, and 5 had morbid obesity. 
      All patients underwent intraoperative transesophageal echocardiography and were 
      being treated with milrinone or nesiritide. Seven patients had intraaortic 
      balloon pumps. All patients underwent coronary artery bypass (CAB), receiving 1 
      to 5 (average, 3.54) grafts per patient. The SVR (Dor) procedure was performed 
      with a Chase Mannequin device. Preoperative end-diastolic volume was 240 to 330 
      mL, and postoperative volume decreased to 110 to 130 mL. Two patients underwent 
      mitral valve repair, and 1 underwent VSD closure. One patient underwent microwave 
      ablation for atrial fibrillation. RESULTS: Ten (91%) of 11 patients were 
      discharged home in 10 to 14 days. There was 1 death: A 78-year-old man with acute 
      MI died 43 days later of septic shock due to hemodialysis. CONCLUSION: End-stage 
      ischemic cardiomyopathy patients with EF <20% can safely undergo surgery after 
      meticulous preoperative preparation to decrease PA pressure, pulmonary capillary 
      wedge pressure, and peripheral vascular resistance and to increase CO by SVR, 
      CAB, and correction of associated lesions. Mortality was 9% with improved 
      hemodynamics and relief of congestive heart failure in all survivors for 3 to 12 
      months.
FAU - Moore, Charles H
AU  - Moore CH
AD  - Christus Santa Rosa Medical Center, San Antonio, Texas, USA. 
      b.davis@christushealth.org
FAU - Nancherla, Swarnalatha
AU  - Nancherla S
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PL  - United States
TA  - Heart Surg Forum
JT  - The heart surgery forum
JID - 100891112
SB  - IM
MH  - Aged
MH  - Cardiomyopathies/complications/*surgery
MH  - Coronary Artery Bypass/*methods
MH  - Female
MH  - Heart Failure/etiology/*prevention & control
MH  - Heart Ventricles/*surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Ischemia/complications/*surgery
MH  - Treatment Outcome
EDAT- 2005/04/01 09:00
MHDA- 2006/12/14 09:00
CRDT- 2005/04/01 09:00
PHST- 2005/04/01 09:00 [pubmed]
PHST- 2006/12/14 09:00 [medline]
PHST- 2005/04/01 09:00 [entrez]
AID - NB8L73TNF1ALU9AY [pii]
AID - 10.1532/HSF98.20041058 [doi]
PST - ppublish
SO  - Heart Surg Forum. 2004;7(5):E420-2. doi: 10.1532/HSF98.20041058.