PMID- 24574440
OWN - NLM
STAT- MEDLINE
DCOM- 20150629
LR  - 20141011
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 46
IP  - 5
DP  - 2014 Nov
TI  - Non-heart transplant surgical approaches with left ventricular restoration and 
      mitral valve operation for advanced ischaemic cardiomyopathy.
PG  - 849-56
LID - 10.1093/ejcts/ezu011 [doi]
AB  - OBJECTIVES: The aim of this study was to assess long-term outcomes of non-heart 
      transplant surgical approaches to advanced ischaemic cardiomyopathy (ICM), 
      including left ventricular restoration (LVR) and mitral valve operation. METHODS: 
      Since September 2002, 102 consecutive patients (mean age 65, 18 females) with 
      advanced ICM [ejection fraction (EF) <40%, left ventricular end-systolic volume 
      index (LVESVI) > 60 ml/m(2)] were treated using non-heart transplant procedures. 
      A total of 84 patients with asynergy of large scar exceeding 35% of left 
      ventricular (LV) perimeter underwent LVR, and 30 patients with greater than or 
      equal to moderate mitral regurgitation (MR) underwent mitral valve operation such 
      as annuloplasty (n = 23) and valve replacement (n = 7). Patients were divided 
      into four groups according to their interagency registry for mechanically 
      assisted circulatory support (INTERMACS) profiles: Profile 1-2 (the highest 
      levels of clinical compromise; n = 9), Profile 3-4 (n = 40), Profile 5-6 (n = 32) 
      and Profile >/= 7 (n = 21). We compared the four groups, looking at survival, major 
      adverse cardiac and cerebrovascular event (MACCE), New York Heart Association 
      (NYHA) status, LV volume and function. RESULTS: The overall 8-year survival 
      including 3 hospital deaths (2.9%) was 64.3% without sudden death due to 
      arrhythmia. Ninety-nine survivors showed significant improvement in the mean NYHA 
      status, from 2.9 to 1.4, and the mean EF (33.2-41.7%) (P < 0.0001). The mean 
      LVESVI was significantly reduced from 104.1 to 61.4 ml/m(2) (41% volume 
      reduction) (P < 0.0001). Seven-year survival in patients with Profiles 1-2, 3-4, 
      5-6 and >/= 7 were 50.0, 57.2, 60.3 and 95.2%, respectively (P = 0.13). Freedom 
      from MACCE at 5 years in patients with Profiles 1-2, 3-4, 5-6 and >/= 7 were 29.6, 
      47.0, 67.2 and 95.2%, respectively (P = 0.0067). The improvements in NYHA status 
      were significantly greater in patients with higher levels of clinical compromise 
      (P < 0.0001), although, there was no significant difference in LV volume 
      reduction and functional improvement among the four groups. Patients with Profile 
      >/= 7 had significantly better survival at 7 years (hazard ratio (HR): 0.11, P = 
      0.046) and freedom from MACCE at 5 years (HR: 0.053, P = 0.0066) compared with 
      patients with Profiles 1-2. CONCLUSIONS: Our non-heart transplant surgical 
      approaches using LVR and mitral valve operation for advanced ICM yielded 
      excellent long-term outcomes in terms of survival and NYHA status, even in 
      patients who are potential candidates for heart transplantation or LV assist 
      devices; and are encouraging in a very particular situation where heart 
      transplantation is limited due to organ storage.
CI  - (c) The Author 2014. Published by Oxford University Press on behalf of the European 
      Association for Cardio-Thoracic Surgery. All rights reserved.
FAU - Cho, Yasunori
AU  - Cho Y
AD  - Department of Cardiovascular Surgery, Tokai University School of Medicine, 
      Isehara, Kanagawa, Japan ynoricho@tokai-u.jp.
FAU - Shimura, Shinichiro
AU  - Shimura S
AD  - Department of Cardiovascular Surgery, Tokai University School of Medicine, 
      Isehara, Kanagawa, Japan.
FAU - Aki, Akira
AU  - Aki A
AD  - Department of Cardiovascular Surgery, Tokai University School of Medicine, 
      Isehara, Kanagawa, Japan.
FAU - Furuya, Hidekazu
AU  - Furuya H
AD  - Department of Cardiovascular Surgery, Tokai University School of Medicine, 
      Isehara, Kanagawa, Japan.
FAU - Odagiri, Shigeto
AU  - Odagiri S
AD  - Department of Cardiovascular Surgery, Tokai University School of Medicine, 
      Isehara, Kanagawa, Japan.
FAU - Okada, Kimiaki
AU  - Okada K
AD  - Department of Cardiovascular Surgery, Tokai University School of Medicine, 
      Isehara, Kanagawa, Japan.
FAU - Ueda, Toshihiko
AU  - Ueda T
AD  - Department of Cardiovascular Surgery, Tokai University School of Medicine, 
      Isehara, Kanagawa, Japan.
LA  - eng
PT  - Journal Article
DEP - 20140226
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
MH  - Aged
MH  - Female
MH  - Health Status
MH  - Heart Ventricles/*surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/*surgery
MH  - Myocardial Ischemia/*surgery
MH  - Postoperative Complications/etiology
MH  - Retrospective Studies
MH  - Survival Analysis
MH  - Treatment Outcome
OTO - NOTNLM
OT  - INTERMACS profiles
OT  - Left ventricular restoration
OT  - Long-term outcomes
OT  - Mitral valve operation
OT  - Non-heart transplant approaches
EDAT- 2014/02/28 06:00
MHDA- 2015/06/30 06:00
CRDT- 2014/02/28 06:00
PHST- 2014/02/28 06:00 [entrez]
PHST- 2014/02/28 06:00 [pubmed]
PHST- 2015/06/30 06:00 [medline]
AID - ezu011 [pii]
AID - 10.1093/ejcts/ezu011 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2014 Nov;46(5):849-56. doi: 10.1093/ejcts/ezu011. Epub 
      2014 Feb 26.