The impact of volume reduction on early and long-term outcomes in surgical ventricular restoration for severe heart failure

Nathan Wm Skelley, Jeremiah G. Allen, George J. Arnaoutakis, Eric S. Weiss, Nishant D. Patel, John Conte

Research output: Contribution to journalArticle

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Abstract

Background Recent published results suggest no additive benefit to surgical ventricular restoration (SVR) when combined with coronary artery bypass grafting. However, there may still be a subgroup of patients with severe heart failure who can benefit from this procedure. We reviewed our institutional experience with SVR to determine early and late outcomes based on volume reduction. Methods We retrospectively reviewed our SVR patients (January 2002 to April 2008) with follow-up to March 2009. Baseline comorbidities, operative data, and postoperative outcomes were assessed by chart review, phone calls, and mailings. Survival was modeled using the Kaplan-Meier method. Cardiac magnetic resonance imaging, myocardial perfusion scans, and echocardiography assessed cardiac function, candidacy for SVR, and volume reduction. Results We reviewed 87 consecutive SVR patients (69 men). Mean age at operation was 61.1 years. Preoperatively, all patients had congestive heart failure, with 80 (92%) at New York Heart Association III/IV. All patients underwent preoperative viability studies. Three-vessel occlusion exceeding 50% was present in 69 (79%). After SVR, ejection fraction improved from 0.236 to 0.332 (p < 0.001). Preoperative and postoperative magnetic resonance imaging in 26 patients (30.0%) showed a 30.8% reduction in left ventricular end systolic volume index. At follow-up, 51 of 66 (77%) improved to New York Heart Association I/II. One intraoperative death occurred. Preoperative left ventricular end systolic volume index of 80 to 120 was associated with improved survival (73% at 3 years). Conclusions SVR is a surgical option for appropriately selected patients with severe congestive heart failure. In these high-risk patients, SVR successfully increased ejection fraction and decreased symptoms. A left ventricular end systolic volume index of 80 to 120 may be the ideal range for SVR procedures.

Original languageEnglish (US)
Pages (from-to)104-112
Number of pages9
JournalAnnals of Thoracic Surgery
Volume91
Issue number1
DOIs
StatePublished - Jan 1 2011

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Heart Failure
Stroke Volume
Survival
Magnetic Resonance Angiography
Coronary Artery Bypass
Echocardiography
Comorbidity
Magnetic Resonance Imaging

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Skelley, Nathan Wm ; Allen, Jeremiah G. ; Arnaoutakis, George J. ; Weiss, Eric S. ; Patel, Nishant D. ; Conte, John. / The impact of volume reduction on early and long-term outcomes in surgical ventricular restoration for severe heart failure. In: Annals of Thoracic Surgery. 2011 ; Vol. 91, No. 1. pp. 104-112.
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abstract = "Background Recent published results suggest no additive benefit to surgical ventricular restoration (SVR) when combined with coronary artery bypass grafting. However, there may still be a subgroup of patients with severe heart failure who can benefit from this procedure. We reviewed our institutional experience with SVR to determine early and late outcomes based on volume reduction. Methods We retrospectively reviewed our SVR patients (January 2002 to April 2008) with follow-up to March 2009. Baseline comorbidities, operative data, and postoperative outcomes were assessed by chart review, phone calls, and mailings. Survival was modeled using the Kaplan-Meier method. Cardiac magnetic resonance imaging, myocardial perfusion scans, and echocardiography assessed cardiac function, candidacy for SVR, and volume reduction. Results We reviewed 87 consecutive SVR patients (69 men). Mean age at operation was 61.1 years. Preoperatively, all patients had congestive heart failure, with 80 (92{\%}) at New York Heart Association III/IV. All patients underwent preoperative viability studies. Three-vessel occlusion exceeding 50{\%} was present in 69 (79{\%}). After SVR, ejection fraction improved from 0.236 to 0.332 (p < 0.001). Preoperative and postoperative magnetic resonance imaging in 26 patients (30.0{\%}) showed a 30.8{\%} reduction in left ventricular end systolic volume index. At follow-up, 51 of 66 (77{\%}) improved to New York Heart Association I/II. One intraoperative death occurred. Preoperative left ventricular end systolic volume index of 80 to 120 was associated with improved survival (73{\%} at 3 years). Conclusions SVR is a surgical option for appropriately selected patients with severe congestive heart failure. In these high-risk patients, SVR successfully increased ejection fraction and decreased symptoms. A left ventricular end systolic volume index of 80 to 120 may be the ideal range for SVR procedures.",
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The impact of volume reduction on early and long-term outcomes in surgical ventricular restoration for severe heart failure. / Skelley, Nathan Wm; Allen, Jeremiah G.; Arnaoutakis, George J.; Weiss, Eric S.; Patel, Nishant D.; Conte, John.

In: Annals of Thoracic Surgery, Vol. 91, No. 1, 01.01.2011, p. 104-112.

Research output: Contribution to journalArticle

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N2 - Background Recent published results suggest no additive benefit to surgical ventricular restoration (SVR) when combined with coronary artery bypass grafting. However, there may still be a subgroup of patients with severe heart failure who can benefit from this procedure. We reviewed our institutional experience with SVR to determine early and late outcomes based on volume reduction. Methods We retrospectively reviewed our SVR patients (January 2002 to April 2008) with follow-up to March 2009. Baseline comorbidities, operative data, and postoperative outcomes were assessed by chart review, phone calls, and mailings. Survival was modeled using the Kaplan-Meier method. Cardiac magnetic resonance imaging, myocardial perfusion scans, and echocardiography assessed cardiac function, candidacy for SVR, and volume reduction. Results We reviewed 87 consecutive SVR patients (69 men). Mean age at operation was 61.1 years. Preoperatively, all patients had congestive heart failure, with 80 (92%) at New York Heart Association III/IV. All patients underwent preoperative viability studies. Three-vessel occlusion exceeding 50% was present in 69 (79%). After SVR, ejection fraction improved from 0.236 to 0.332 (p < 0.001). Preoperative and postoperative magnetic resonance imaging in 26 patients (30.0%) showed a 30.8% reduction in left ventricular end systolic volume index. At follow-up, 51 of 66 (77%) improved to New York Heart Association I/II. One intraoperative death occurred. Preoperative left ventricular end systolic volume index of 80 to 120 was associated with improved survival (73% at 3 years). Conclusions SVR is a surgical option for appropriately selected patients with severe congestive heart failure. In these high-risk patients, SVR successfully increased ejection fraction and decreased symptoms. A left ventricular end systolic volume index of 80 to 120 may be the ideal range for SVR procedures.

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