PMID- 16364872
OWN - NLM
STAT- MEDLINE
DCOM- 20060707
LR  - 20121115
IS  - 1557-3117 (Electronic)
IS  - 1053-2498 (Linking)
VI  - 24
IP  - 12
DP  - 2005 Dec
TI  - Surgical ventricular remodeling for patients with clinically advanced congestive 
      heart failure and severe left ventricular dysfunction.
PG  - 2202-10
AB  - 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.
FAU - Patel, Nishant D
AU  - Patel ND
AD  - Heart and Lung Transplant Division of Cardiac Surgery, Johns Hopkins Medical 
      Institutions, Baltimore, Maryland 21287, USA.
FAU - Barreiro, Christopher J
AU  - Barreiro CJ
FAU - Williams, Jason A
AU  - Williams JA
FAU - Bonde, Pramod N
AU  - Bonde PN
FAU - Waldron, Michele
AU  - Waldron M
FAU - Natori, Shunsuke
AU  - Natori S
FAU - Bluemke, David A
AU  - Bluemke DA
FAU - Conte, John V
AU  - Conte JV
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20050915
PL  - United States
TA  - J Heart Lung Transplant
JT  - The Journal of heart and lung transplantation : the official publication of the 
      International Society for Heart Transplantation
JID - 9102703
SB  - IM
MH  - Aged
MH  - Cardiac Catheterization
MH  - Echocardiography
MH  - Female
MH  - Heart Failure/*surgery
MH  - Humans
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/complications
MH  - Quality of Life
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/etiology/*surgery
MH  - *Ventricular Remodeling
EDAT- 2005/12/21 09:00
MHDA- 2006/07/11 09:00
CRDT- 2005/12/21 09:00
PHST- 2005/04/07 00:00 [received]
PHST- 2005/06/21 00:00 [revised]
PHST- 2005/06/24 00:00 [accepted]
PHST- 2005/12/21 09:00 [pubmed]
PHST- 2006/07/11 09:00 [medline]
PHST- 2005/12/21 09:00 [entrez]
AID - S1053-2498(05)00439-0 [pii]
AID - 10.1016/j.healun.2005.06.024 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2005 Dec;24(12):2202-10. doi: 
      10.1016/j.healun.2005.06.024. Epub 2005 Sep 15.