Non-heart transplant surgical approaches with left ventricular restoration and mitral valve operation for advanced ischaemic cardiomyopathy
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 f...
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| Veröffentlicht in: | European journal of cardio-thoracic surgery 2014-11, Vol.46 (5), p.849-856 |
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| creator | Cho, Yasunori Shimura, Shinichiro Aki, Akira Furuya, Hidekazu Odagiri, Shigeto Okada, Kimiaki Ueda, Toshihiko |
| description | 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) 60 ml/m2] 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/m2 (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 a |
| doi_str_mv | 10.1093/ejcts/ezu011 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1610763326</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/ejcts/ezu011</oup_id><sourcerecordid>1610763326</sourcerecordid><originalsourceid>FETCH-LOGICAL-c361t-b0741fd97ef2de8c5f942ddb916c0bf3fdaca07072325a2df9b9b93c973500913</originalsourceid><addsrcrecordid>eNp9kMFu1DAQhi0EYreFG2fkGxwaOo6z8eaIqtIiVfRSJG7RxB4Tr5I42M6i5RX60jXswhH5MJbm06f5f8beCPggoJGXtNMpXtKvBYR4xtZiq2ShZPXtef6DgEI1FazYWYw7AKhlqV6yVVltVFVVsGaPX_xU9IQh8RRwivOAU-JxCd-dxoHjPAePuqfIf7rU84Fs4nuaUnB6GTDwQDH5gMn5ieNk-OiyZuB7HPbE_UynlfWBo9njpMlwF3WPNDrNNQbj_HjwM6b-8Iq9sDhEen2a5-zrp-uHq9vi7v7m89XHu0LLWqSiA1UJaxpFtjS01RvbVKUxXSNqDZ2V1qBGUKBKWW6wNLbp8pO6UXID0Ah5zt4fvTnbjyUHaMd8Eg05OvkltqIWoGopyzqjF0dUBx9jINvOwY0YDq2A9nf97Z_622P9GX97Mi_dSOYf_LfvDLw7An6Z_696AlJMlKg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1610763326</pqid></control><display><type>article</type><title>Non-heart transplant surgical approaches with left ventricular restoration and mitral valve operation for advanced ischaemic cardiomyopathy</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Cho, Yasunori ; Shimura, Shinichiro ; Aki, Akira ; Furuya, Hidekazu ; Odagiri, Shigeto ; Okada, Kimiaki ; Ueda, Toshihiko</creator><creatorcontrib>Cho, Yasunori ; Shimura, Shinichiro ; Aki, Akira ; Furuya, Hidekazu ; Odagiri, Shigeto ; Okada, Kimiaki ; Ueda, Toshihiko</creatorcontrib><description>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/m2] 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/m2 (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.</description><identifier>ISSN: 1010-7940</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1093/ejcts/ezu011</identifier><identifier>PMID: 24574440</identifier><language>eng</language><publisher>Germany: Oxford University Press</publisher><subject>Aged ; Female ; Health Status ; Heart Ventricles - surgery ; Humans ; Male ; Middle Aged ; Mitral Valve - surgery ; Myocardial Ischemia - surgery ; Postoperative Complications - etiology ; Retrospective Studies ; Survival Analysis ; Treatment Outcome</subject><ispartof>European journal of cardio-thoracic surgery, 2014-11, Vol.46 (5), p.849-856</ispartof><rights>The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2014</rights><rights>The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c361t-b0741fd97ef2de8c5f942ddb916c0bf3fdaca07072325a2df9b9b93c973500913</citedby><cites>FETCH-LOGICAL-c361t-b0741fd97ef2de8c5f942ddb916c0bf3fdaca07072325a2df9b9b93c973500913</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24574440$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cho, Yasunori</creatorcontrib><creatorcontrib>Shimura, Shinichiro</creatorcontrib><creatorcontrib>Aki, Akira</creatorcontrib><creatorcontrib>Furuya, Hidekazu</creatorcontrib><creatorcontrib>Odagiri, Shigeto</creatorcontrib><creatorcontrib>Okada, Kimiaki</creatorcontrib><creatorcontrib>Ueda, Toshihiko</creatorcontrib><title>Non-heart transplant surgical approaches with left ventricular restoration and mitral valve operation for advanced ischaemic cardiomyopathy</title><title>European journal of cardio-thoracic surgery</title><addtitle>Eur J Cardiothorac Surg</addtitle><description>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/m2] 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/m2 (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.</description><subject>Aged</subject><subject>Female</subject><subject>Health Status</subject><subject>Heart Ventricles - surgery</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mitral Valve - surgery</subject><subject>Myocardial Ischemia - surgery</subject><subject>Postoperative Complications - etiology</subject><subject>Retrospective Studies</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>1010-7940</issn><issn>1873-734X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMFu1DAQhi0EYreFG2fkGxwaOo6z8eaIqtIiVfRSJG7RxB4Tr5I42M6i5RX60jXswhH5MJbm06f5f8beCPggoJGXtNMpXtKvBYR4xtZiq2ShZPXtef6DgEI1FazYWYw7AKhlqV6yVVltVFVVsGaPX_xU9IQh8RRwivOAU-JxCd-dxoHjPAePuqfIf7rU84Fs4nuaUnB6GTDwQDH5gMn5ieNk-OiyZuB7HPbE_UynlfWBo9njpMlwF3WPNDrNNQbj_HjwM6b-8Iq9sDhEen2a5-zrp-uHq9vi7v7m89XHu0LLWqSiA1UJaxpFtjS01RvbVKUxXSNqDZ2V1qBGUKBKWW6wNLbp8pO6UXID0Ah5zt4fvTnbjyUHaMd8Eg05OvkltqIWoGopyzqjF0dUBx9jINvOwY0YDq2A9nf97Z_622P9GX97Mi_dSOYf_LfvDLw7An6Z_696AlJMlKg</recordid><startdate>201411</startdate><enddate>201411</enddate><creator>Cho, Yasunori</creator><creator>Shimura, Shinichiro</creator><creator>Aki, Akira</creator><creator>Furuya, Hidekazu</creator><creator>Odagiri, Shigeto</creator><creator>Okada, Kimiaki</creator><creator>Ueda, Toshihiko</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201411</creationdate><title>Non-heart transplant surgical approaches with left ventricular restoration and mitral valve operation for advanced ischaemic cardiomyopathy</title><author>Cho, Yasunori ; Shimura, Shinichiro ; Aki, Akira ; Furuya, Hidekazu ; Odagiri, Shigeto ; Okada, Kimiaki ; Ueda, Toshihiko</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c361t-b0741fd97ef2de8c5f942ddb916c0bf3fdaca07072325a2df9b9b93c973500913</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Female</topic><topic>Health Status</topic><topic>Heart Ventricles - surgery</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mitral Valve - surgery</topic><topic>Myocardial Ischemia - surgery</topic><topic>Postoperative Complications - etiology</topic><topic>Retrospective Studies</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cho, Yasunori</creatorcontrib><creatorcontrib>Shimura, Shinichiro</creatorcontrib><creatorcontrib>Aki, Akira</creatorcontrib><creatorcontrib>Furuya, Hidekazu</creatorcontrib><creatorcontrib>Odagiri, Shigeto</creatorcontrib><creatorcontrib>Okada, Kimiaki</creatorcontrib><creatorcontrib>Ueda, Toshihiko</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of cardio-thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cho, Yasunori</au><au>Shimura, Shinichiro</au><au>Aki, Akira</au><au>Furuya, Hidekazu</au><au>Odagiri, Shigeto</au><au>Okada, Kimiaki</au><au>Ueda, Toshihiko</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Non-heart transplant surgical approaches with left ventricular restoration and mitral valve operation for advanced ischaemic cardiomyopathy</atitle><jtitle>European journal of cardio-thoracic surgery</jtitle><addtitle>Eur J Cardiothorac Surg</addtitle><date>2014-11</date><risdate>2014</risdate><volume>46</volume><issue>5</issue><spage>849</spage><epage>856</epage><pages>849-856</pages><issn>1010-7940</issn><eissn>1873-734X</eissn><abstract>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/m2] 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/m2 (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.</abstract><cop>Germany</cop><pub>Oxford University Press</pub><pmid>24574440</pmid><doi>10.1093/ejcts/ezu011</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Aged Female Health Status Heart Ventricles - surgery Humans Male Middle Aged Mitral Valve - surgery Myocardial Ischemia - surgery Postoperative Complications - etiology Retrospective Studies Survival Analysis Treatment Outcome |
| title | Non-heart transplant surgical approaches with left ventricular restoration and mitral valve operation for advanced ischaemic cardiomyopathy |
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