PMID- 16928501
OWN - NLM
STAT- MEDLINE
DCOM- 20060913
LR  - 20191210
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 82
IP  - 3
DP  - 2006 Sep
TI  - Surgical ventricular restoration for advanced congestive heart failure: should 
      pulmonary hypertension be a contraindication?
PG  - 879-88; discussion 888
AB  - BACKGROUND: Surgical ventricular restoration (SVR) is an established therapy for 
      congestive heart failure due to ischemic cardiomyopathy. Pulmonary hypertension 
      (PHTN) has been considered a contraindication for SVR owing to a presumed 
      increase in operative risk. However, outcomes in these patients and the impact of 
      SVR on PHTN have not been specifically evaluated. METHODS: We retrospectively 
      reviewed SVR patients between January 2002 and June 2005. Patients were 
      classified as PHTN (mean pulmonary artery pressure > or = 25 mm Hg) and no PHTN 
      (mPAP < 25 mm Hg) based on preoperative cardiac catheterization. Cardiac function 
      was assessed using magnetic resonance imaging and echocardiography. Follow-up was 
      100%. RESULTS: Sixty-nine patients underwent SVR for congestive heart failure. 
      Thirty-six percent (25 of 69) had preoperative PHTN. Preoperatively, PHTN 
      patients had significantly lower ejection fraction (21.1% versus 30.0%; p = 
      0.005) and larger left ventricular end-systolic volume index (119.0 versus 88.7 
      mL/m2; p = 0.04) than patients without PHTN. All PHTN patients and 95.5% (42 of 
      44) of the no PHTN group were New York Heart Association (NYHA) class III/IV 
      preoperatively. There was 1 operative death in the PHTN group. Surgical 
      ventricular restoration significantly improved cardiac function and pulmonary 
      pressures for PHTN patients. Both groups had similar cardiac function 
      postoperatively. Seventy-two percent (18 of 25) of PHTN patients and 69.0% (29 of 
      42) of patients without PHTN improved to NYHA class I/II at follow-up. 
      Kaplan-Meier survival of PHTN patients was 68.1% at 3 years, which was lower than 
      patients without PHTN (81.4%; p = 0.44), but not statistically significant. 
      Kaplan-Meier 3-year survival for all SVR patients was 76.6%. CONCLUSIONS: 
      Surgical ventricular restoration is a good treatment option in patients with 
      advanced congestive heart failure and PHTN. Our early results are promising and 
      should prompt further studies to confirm these findings.
FAU - Patel, Nishant D
AU  - Patel ND
AD  - Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, 
      Maryland 21287, USA.
FAU - Williams, Jason A
AU  - Williams JA
FAU - Nwakanma, Lois U
AU  - Nwakanma LU
FAU - Waldron, Michele M
AU  - Waldron MM
FAU - Bluemke, David A
AU  - Bluemke DA
FAU - Conte, John V
AU  - Conte JV
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Aged
MH  - *Cardiac Surgical Procedures
MH  - Comorbidity
MH  - Contraindications
MH  - Coronary Artery Bypass/statistics & numerical data
MH  - Female
MH  - Heart Failure/complications/*surgery
MH  - Heart Ventricles/*surgery
MH  - Humans
MH  - Hypertension, Pulmonary/*complications
MH  - Length of Stay/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve Insufficiency/complications/surgery
MH  - Postoperative Complications/epidemiology
MH  - Proportional Hazards Models
MH  - Retrospective Studies
MH  - Risk
MH  - Stroke Volume
MH  - Treatment Outcome
EDAT- 2006/08/25 09:00
MHDA- 2006/09/14 09:00
CRDT- 2006/08/25 09:00
PHST- 2006/01/27 00:00 [received]
PHST- 2006/03/31 00:00 [revised]
PHST- 2006/04/03 00:00 [accepted]
PHST- 2006/08/25 09:00 [pubmed]
PHST- 2006/09/14 09:00 [medline]
PHST- 2006/08/25 09:00 [entrez]
AID - S0003-4975(06)00708-9 [pii]
AID - 10.1016/j.athoracsur.2006.04.016 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2006 Sep;82(3):879-88; discussion 888. doi: 
      10.1016/j.athoracsur.2006.04.016.