PMID- 17023172
OWN - NLM
STAT- MEDLINE
DCOM- 20070308
LR  - 20191210
IS  - 1010-7940 (Print)
IS  - 1010-7940 (Linking)
VI  - 30
IP  - 5
DP  - 2006 Nov
TI  - The impact of left ventricular reconstruction on survival in patients with 
      ischemic cardiomyopathy.
PG  - 753-9
AB  - OBJECTIVE: Left ventricular reconstruction (LVR) is performed to improve the 
      morphologic structure and function of the heart in patients with heart failure. 
      This procedure has been performed at the Cleveland Clinic Foundation since 1997. 
      We assessed mortality, functional status, and predictors of outcome in these 
      patients. METHODS: Data were extracted from multiple prospectively acquired 
      datasets on demographic, clinical, and operative details of 220 consecutive 
      patients who underwent LVR between July 1997 and July 2003, where the indication 
      for surgery was heart failure (of whom 66% had New York Heart Association (NYHA) 
      functional class III or IV symptoms). Mortality, functional status, and 
      postoperative complications were ascertained by reference to the clinical record, 
      social security death index, and by phone contact. Mean preoperative left 
      ventricular ejection fraction (LVEF) was 21.5+/-7.3% and mean left ventricular 
      end-diastolic diameter was 6.4+/-1.0 cm. The mean age was 61.4+/-9.0 years and 
      80% were male. The majority (86%) of patients underwent concomitant coronary 
      artery bypass grafting and 49% underwent mitral valve surgery. RESULTS: 
      Thirty-day mortality was 1% and survival at 1, 3, and 5 years was 92%, 90%, and 
      80%, respectively. Of the survivors for whom data on NYHA functional class were 
      available, 85% were in NYHA functional class I or II. Mortality was predicted by 
      reduced preoperative ejection fraction <20% (unadjusted hazard ratio 1.53, p = 
      0.02), body mass index < or = 24 kg/m2 (unadjusted hazard ratio 1.69, p = 0.01), 
      QRS duration > or = 130 ms (unadjusted hazard ratio 1.66, p = 0.01) and the 
      requirement for renal replacement therapy postoperatively (unadjusted hazard 
      ratio 3.85, p < 0.01). Mean LVEF improved to 24.7+/-8.86% (p < 0.01) and left 
      ventricular volumes were also significantly reduced. CONCLUSIONS: In selected 
      patients with heart failure, LVR, in conjunction with revascularization and valve 
      surgery, is associated with excellent survival, improved symptoms, and improved 
      LVEF and left ventricular dimensions.
FAU - O'Neill, James O
AU  - O'Neill JO
AD  - Department of Cardiovascular Medicine, Cleveland Clinic, Desk 25, 9500 Euclid 
      Avenue, Cleveland, OH 44195, USA.
FAU - Starling, Randall C
AU  - Starling RC
FAU - McCarthy, Patrick M
AU  - McCarthy PM
FAU - Albert, Nancy M
AU  - Albert NM
FAU - Lytle, Bruce W
AU  - Lytle BW
FAU - Navia, Jose
AU  - Navia J
FAU - Young, James B
AU  - Young JB
FAU - Smedira, Nicholas
AU  - Smedira N
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20061004
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
CIN - Eur J Cardiothorac Surg. 2006 Nov;30(5):759-61. PMID: 16978871
MH  - Aged
MH  - Cardiomyopathy, Dilated/mortality/physiopathology/*surgery
MH  - Coronary Artery Bypass
MH  - Epidemiologic Methods
MH  - Female
MH  - Heart Ventricles/pathology/surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve Insufficiency/surgery
MH  - Myocardial Ischemia/mortality/physiopathology/*surgery
MH  - Postoperative Complications
MH  - Stroke Volume
MH  - Treatment Outcome
EDAT- 2006/10/07 09:00
MHDA- 2007/03/09 09:00
CRDT- 2006/10/07 09:00
PHST- 2006/06/14 00:00 [received]
PHST- 2006/07/17 00:00 [revised]
PHST- 2006/07/19 00:00 [accepted]
PHST- 2006/10/07 09:00 [pubmed]
PHST- 2007/03/09 09:00 [medline]
PHST- 2006/10/07 09:00 [entrez]
AID - S1010-7940(06)00695-6 [pii]
AID - 10.1016/j.ejcts.2006.07.018 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2006 Nov;30(5):753-9. doi: 10.1016/j.ejcts.2006.07.018. 
      Epub 2006 Oct 4.