Influence of baseline left ventricular function on the clinical outcome of surgical ventricular reconstruction in patients with ischaemic cardiomyopathy

Oh, Jae K.; Velázquez, Eric J.; Menicanti, Lorenzo; Pohost, Gerald M.; Bonow, Robert O.; Lin, Grace; Hellkamp, Anne S.; Ferrazzi, Paolo; Woś, Stanisław; Rao, Vivek; Berman, Daniel S.; Bochenek, Andrzej; Cherniavsky, Alexander; Rogowski, Jan; Rouleau, Jean L.; Lee, Kerry L.

doi:10.1093/eurheartj/ehs021

Cited by 69 publications

(70 citation statements)

References 21 publications

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“…252 Subgroup analyses of patients with a less dilated LV and better LVEF showed benefit from SVR. 253 In the STICH trial, a post-operative LV end-systolic volume index < _70 mL/m 2 , after CABG plus SVR, resulted in improved survival compared with CABG alone. 252,254 In experienced centres, SVR may be done at the time of CABG if HF Routine revascularization of non-IRA lesions should be considered in patients with multivessel disease before hospital discharge.…”

Section: Ventricular Reconstruction and Aneurysm Resectionmentioning

confidence: 99%

See 1 more Smart Citation

2018 ESC/EACTS Guidelines on myocardial revascularization

Neumann¹,

Ahlsson²,

Alfonso³

et al. 2018

European Heart Journal

5,223

2,078

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Section: Ventricular Reconstruction and Aneurysm Resectionmentioning

confidence: 99%

“…[252][253][254]256,257 IIb B CABG = coronary artery bypass grafting; LV = left ventricular; NYHA = New York Heart Association; PCI = percutaneous coronary intervention. …”

Section: Iia Cmentioning

confidence: 99%

2018 ESC/EACTS Guidelines on myocardial revascularization

Neumann¹,

Ahlsson²,

Alfonso³

et al. 2018

European Heart Journal

5,223

2,078

View full text Add to dashboard Cite

“…Earlier clinical reports demonstrated that there were various preoperative risk factors including low EF and severity of MR in patients with ICM. 17,18) However, the results would not be fairly compared due to uneven patient background. Additionally, surgical risk in our series would be much higher than that in Yamaguchi's report, because the severity of MR would be apparently greater in our patients.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Long-Term Survival in Patients with End-Stage Heart Failure Secondary to Ischemic Heart Disease: Surgical Correction and Volumetric Analysis

Yoshida

Hirota

Hoshino

et al. 2015

ATCS

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Purpose: Ischemic heart disease (IHD) may result in lethal conditions such as ischemic cardiomyopathy (ICM) and mitral regurgitation (MR). Methods: We hypothesized preoperative LV volume would be highly associated with longterm survival in such patients. We retrospectively evaluated effects of LV end-systolic volume index (LVESVI) on survival. Results: Patients were divided into two groups according to LVESVI; Group S (n = 19, <100 ml/m 2 ), and L (n = 55, >100 ml/m 2 ). There were 74 patients (male 61, female 13; 61 ± 10 y.o.). There was no statistical significance in preoperative parameters, including ejection fraction (EF), severity of MR, severity of tricuspid regurgitation (TR), and right ventricular systolic pressure (RVSP). After operation, LVESVI and severity of MR were statistically reduced in both groups. However, EF, severity of TR and RVSP were not statistically alleviated in both groups. In Group S, 5-and 10-year survival rates were 93% and 48%. In Group L, 5-and 10-year survival rates were 50% and 29%. There was a statistical difference in long-term survival between two groups. Conclusions: Preoperative LV volume would be one of the risk factors for long-term survival in patients with congestive heart failure secondary to IHD. Careful follow-up and optimal treatment should be recommended before LV dimension becomes too large.

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“…30,31 Furthermore, the extent of myocardial viability in the dysfunctional anterior wall does not appear to be an important determinant of survival in patients undergoing SVR. 32 It is difficult to imagine another trial of this nature, which was an enormous international effort, being carried out.…”

Section: Ventricular Reconstruction Hypothesismentioning

confidence: 99%

Managing Heart Failure Patients with Multivessel Disease — Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention

Pepper¹

2015

Cardiac Failure Review

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The most common cause of heart failure with reduced ejection fraction (HFrEF) in the industrialised world is coronary heart disease. 1Patients with an ischaemic aetiology of left ventricular systolic dysfunction have significantly higher mortality rates than those with non-ischaemic aetiologies.2 This more aggressive course represents the convergence of ischaemic myocardial fibrosis and endothelial dysfunction, which are superimposed on the progressive nature of the left ventricular dysfunction often with comorbidities such as diabetes and hypertension. The foundation of treatment for HFrEF is guidelinedirected medical treatment.3 This is associated with a significant improvement in survival and quality of life, but not a return to normal activities. The most commonly considered surgical interventions for patients with HFrEF are coronary artery bypass surgery, sometimes combined with surgical ventricular reconstruction (SVR) and surgery for mitral regurgitation.Percutaneous coronary intervention (PCI) has been less well studied in this setting. In a recent retrospective study from Alberta, Canada, Nagendran and colleagues identified 2,925 patients with coronary artery disease and left ventricular dysfunction (ejection fraction <35 %) of whom 1,326 underwent surgery and 1,599 received PCI. 4 In a Cox proportional hazard analysis of the propensity-matched subgroups, surgery resulted in significantly lower rates of repeat revascularisation and better survival rates compared with PCI at 1, 5, 10 and 15 years.Following the SYNTAX study, the recommendation for patients with multivessel disease is invariably surgery and not PCI especially if the SYNTAX score is >30.5 Transplantation and left ventricular assist devices are indicated in highly selected patients with advanced disease. 6 In patients with HFrEF who have coronary artery disease the essential question is whether flow-limiting obstructions should be treated with coronary artery bypass surgery.About 30 years ago two celebrated randomised trials of coronary artery surgery were carried out. By modern standards of statistical evaluation the results should probably be considered neutral. Each trial managed to find a subgroup, usually not pre-specified, with a positive result. The Coronary Artery Surgery Study (CASS) noted that a subgroup of 78 patients with three-vessel disease and a left ventricular ejection fraction (LVEF) of 35-50 % had a 5-year mortality rate of 10 % where assigned to surgery and 19 % where assigned to medical treatment, which rose to 12 % and 35 %, respectively, at 7 years (p=0.009).7 Most of these patients had angina, few had heart failure and patients with an LVEF <35 % were excluded.The Veterans Administration Coronary Artery Bypass Study included 325 patients with impaired left ventricular function but excluded patients with 'serious heart disease'. 8 The 5-year mortality rates were 20 % with surgery and 27 % with medical treatment (non-significant difference).The 7-year mortality rates were 26 % with surgery and 37 % with medical treatmen...

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Influence of baseline left ventricular function on the clinical outcome of surgical ventricular reconstruction in patients with ischaemic cardiomyopathy

Abstract: Subgroup analyses of the STICH trial suggest that patients with less dilated LV and better LVEF may benefit from SVR, while those with larger LV and poorer LVEF may do worse. Clinical Trial Registration #: NCT00023595.

Cited by 69 publications

References 21 publications

2018 ESC/EACTS Guidelines on myocardial revascularization

2018 ESC/EACTS Guidelines on myocardial revascularization

Prediction of Long-Term Survival in Patients with End-Stage Heart Failure Secondary to Ischemic Heart Disease: Surgical Correction and Volumetric Analysis

Managing Heart Failure Patients with Multivessel Disease — Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention

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