JTCS Click here to go to SJM website.
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
 QUICK SEARCH:   [advanced]


     


This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Lorenzo Menicanti
Marco Ranucci
Alessandro Frigiola
Carlo de Vincentiis
Marisa Di Donato
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Menicanti, L.
Right arrow Articles by Di Donato, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Menicanti, L.
Right arrow Articles by Di Donato, M.
Related Collections
Right arrow Congestive Heart Failure
Right arrow Coronary disease
Right arrowRelated Articles

J Thorac Cardiovasc Surg 2007;134:433-441
© 2007 The American Association for Thoracic Surgery


Surgery for Acquired Cardiovascular Disease

Surgical therapy for ischemic heart failure: Single-center experience with surgical anterior ventricular restoration

Lorenzo Menicanti, MDa,1, Serenella Castelvecchio, MDa, Marco Ranucci, MDa, Alessandro Frigiola, MDa, Carlo Santambrogio, MDa, Carlo de Vincentiis, MDa, Jelena Brankovic, MDa, Marisa Di Donato, MDb,1,*

a Cardiac Surgery Department, San Donato Hospital, Milano, Italy
b Critical Care Medicine Department, University of Florence, Florence, Italy.

Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29-May 3, 2006.

Received for publication June 13, 2006; revisions received November 13, 2006; accepted for publication December 1, 2006.

* Address for reprints: Marisa Di Donato, MD, Cardiac Surgery Department, San Donato Hospital, Via Morandi 30, San Donato Milanese, Milan, Italy. (Email: marad{at}tin.it).

Objectives: Our objectives were (1) to report operative and long-term mortality in patients submitted to anterior surgical ventricular restoration, (2) to report changes in clinical and cardiac status induced by surgical ventricular restoration, and (3) to report predictors of death in a large cohort of patients operated on at San Donato Hospital, Milan, Italy.

Methods: A total of 1161 consecutive patients (83% men, 62 ± 10 years) had anterior surgical ventricular restoration with or without coronary artery bypass grafting and with or without mitral repair/replacement. A complete echocardiographic study was performed in 488 of 1161 patients operated on between January 1998 and October 2005 (study group). The indication for surgery was heart failure in 60% of patients, angina, and/or a combination of the two.

Results: Thirty-day cardiac mortality was 4.7% (55/1161) in the overall group and 4.9% (24/488) in the study group. Determinants of hospital mortality were mitral valve regurgitation and need for a mitral valve repair/replacement. Mitral regurgitation (>2+) associated with a New York Heart Association class greater than II and with diastolic dysfunction (early-to-late diastolic filling pressure >2) further increases mortality risk. Global systolic function improved postoperatively: ejection fraction improved from 33% ± 9% to 40% ± 10% (P < .001); end-diastolic and end-systolic volumes decreased from 211 ± 73 to 142 ± 50 and 145 ± 64 to 88 ± 40 mL, respectively (P < .001) early after surgery. New York Heart Association functional class improved from 2.7 ± 0.9 to 1.6 ± 0.7 (P < .001) late after surgery. Long-term survival in the overall population was 63% at 120 months.

Conclusions: Surgical ventricular restoration for ischemic heart failure reduces ventricular volumes, improves cardiac function and functional status, carries an acceptable operative mortality, and results in good long-term survival. Predictors of operative mortality are mitral regurgitation of 2+ or more, New York Heart Association class greater than II, and diastolic dysfunction (early-to-late diastolic filling pressure >2).



Abbreviations and Acronyms AUC = area under the curve; CABG = coronary artery bypass grafting; E/A = early-to-late diastolic filling pressure; EF = ejection fraction; HF = heart failure; LV = left ventricular; MR = mitral regurgitation; NYHA = New York Heart Association; ROC = receiver operating characteristic; STICH = Surgical Treatment of IsChemic Heart failure (trial); SVR = surgical ventricular restoration



Related Articles

The effect of preoperative diastolic dysfunction on outcome after surgical ventricular remodeling
Mark B. Ratcliffe and T. Sloane Guy
J. Thorac. Cardiovasc. Surg. 2007 134: 280-283. [Extract] [Full Text] [PDF]

Discussion
J. Thorac. Cardiovasc. Surg. 2007 134: 439-441. [Extract] [Full Text] [PDF]



This article has been cited by other articles:


Home page
Ann. Thorac. Surg.Home page
S. Castelvecchio, M. Ranucci, M. Di Donato, and L. Menicanti
Diabetes mellitus and long-term outcome in heart failure patients after surgical ventricular restoration.
Ann. Thorac. Surg., November 1, 2009; 88(5): 1451 - 1456.
[Abstract] [Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
G. D. Buckberg and C. L. Athanasuleas
The STICH trial: Misguided conclusions.
J. Thorac. Cardiovasc. Surg., November 1, 2009; 138(5): 1060 - 1064.e2.
[Full Text] [PDF]


Home page
CirculationHome page
M. V. Badiwala, S. Verma, and V. Rao
Surgical Management of Ischemic Mitral Regurgitation
Circulation, September 29, 2009; 120(13): 1287 - 1293.
[Full Text] [PDF]


Home page
Eur. J. Cardiothorac. Surg.Home page
H. Suma, H. Tanabe, T. Uejima, T. Isomura, and T. Horii
Surgical ventricular restoration combined with mitral valve procedure for endstage ischemic cardiomyopathy
Eur. J. Cardiothorac. Surg., August 1, 2009; 36(2): 280 - 285.
[Abstract] [Full Text] [PDF]


Home page
Eur. J. Cardiothorac. Surg.Home page
P. Klein, E. R. Holman, M. I.M. Versteegh, E. Boersma, H. F. Verwey, J. J. Bax, R. A.E. Dion, and R. J.M. Klautz
Wall motion score index predicts mortality and functional result after surgical ventricular restoration for advanced ischemic heart failure
Eur. J. Cardiothorac. Surg., May 1, 2009; 35(5): 847 - 853.
[Abstract] [Full Text] [PDF]


Home page
NEJMHome page
H. J. Eisen
Surgical Ventricular Reconstruction for Heart Failure
N. Engl. J. Med., April 23, 2009; 360(17): 1781 - 1784.
[Full Text] [PDF]


Home page
NEJMHome page
R. H. Jones, E. J. Velazquez, R. E. Michler, G. Sopko, J. K. Oh, C. M. O'Connor, J. A. Hill, L. Menicanti, Z. Sadowski, P. Desvigne-Nickens, et al.
Coronary Bypass Surgery with or without Surgical Ventricular Reconstruction
N. Engl. J. Med., April 23, 2009; 360(17): 1705 - 1717.
[Abstract] [Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
H.-Y. Yu, Y.-S. Chen, W.-Y. Tseng, N.-S. Chi, C.-H. Wang, S.-S. Wang, and F.-Y. Lin
Why is the surgical ventricular restoration operation effective for ischemic cardiomyopathy? Geometric analysis with magnetic resonance imaging of changes in regional ventricular function after surgical ventricular restoration
J. Thorac. Cardiovasc. Surg., April 1, 2009; 137(4): 887 - 894.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
M. Di Donato, S. Castelvecchio, T. Kukulski, C. Bussadori, F. Giacomazzi, A. Frigiola, and L. Menicanti
Surgical ventricular restoration: left ventricular shape influence on cardiac function, clinical status, and survival.
Ann. Thorac. Surg., February 1, 2009; 87(2): 455 - 461.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
S. Castelvecchio, L. Menicanti, M. Ranucci, and M. Di Donato
Impact of Surgical Ventricular Restoration on Diastolic Function: Implications of Shape and Residual Ventricular Size
Ann. Thorac. Surg., December 1, 2008; 86(6): 1849 - 1854.
[Abstract] [Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
V. Dor, F. Civaia, C. Alexandrescu, and F. Montiglio
The post-myocardial infarction scarred ventricle and congestive heart failure: the preeminence of magnetic resonance imaging for preoperative, intraoperative, and postoperative assessment.
J. Thorac. Cardiovasc. Surg., December 1, 2008; 136(6): 1405 - 1412.
[Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
K. Takeda, G. Matsumiya, H. Matsue, S. Hamada, M. Sakaki, T. Sakaguchi, T. Fujita, and Y. Sawa
Use of quantitative analysis of remote myocardial fibrosis with delayed-enhancement magnetic resonance imaging to predict outcomes after surgical ventricular restoration for ischemic cardiomyopathy.
J. Thorac. Cardiovasc. Surg., December 1, 2008; 136(6): 1514 - 1521.
[Abstract] [Full Text] [PDF]


Home page
Asian Cardiovasc. Thorac. Ann.Home page
M. Di Donato, L. Menicanti, and H. Suma
Surgical Ventricular Restoration and the STICH Trial
Asian Cardiovasc Thorac Ann, August 1, 2008; 16(4): 269 - 271.
[Full Text] [PDF]


Home page
ICVTSHome page
H. Subramanian, B. Kunadian, and J. Dunning
Is it worth performing surgical ventricular restoration in patients with ischemic cardiomyopathy and akinetic but non-aneurysmal segments in the left ventricle?
Interactive CardioVascular and Thoracic Surgery, August 1, 2008; 7(4): 702 - 707.
[Abstract] [Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
M. B. Ratcliffe and T. S. Guy
The effect of preoperative diastolic dysfunction on outcome after surgical ventricular remodeling
J. Thorac. Cardiovasc. Surg., August 1, 2007; 134(2): 280 - 283.
[Full Text] [PDF]




HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2007 by The American Association for Thoracic Surgery.