Surgical Ventricular Restoration for Advanced Congestive Heart Failure: Should Pulmonary Hypertension Be a Contraindication?

Surgical ventricular restoration (SVR) is an established therapy for congestive heart failure due to ischemic cardiomyopathy. Pulmonary hypertension (PHTN) has been considered a contraindication for SVR owing to a presumed increase in operative risk. However, outcomes in these patients and the impac...

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Veröffentlicht in:The Annals of thoracic surgery 2006-09, Vol.82 (3), p.879-888
Hauptverfasser: Patel, Nishant D., Williams, Jason A., Nwakanma, Lois U., Waldron, Michele M., Bluemke, David A., Conte, John V.
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container_end_page 888
container_issue 3
container_start_page 879
container_title The Annals of thoracic surgery
container_volume 82
creator Patel, Nishant D.
Williams, Jason A.
Nwakanma, Lois U.
Waldron, Michele M.
Bluemke, David A.
Conte, John V.
description Surgical ventricular restoration (SVR) is an established therapy for congestive heart failure due to ischemic cardiomyopathy. Pulmonary hypertension (PHTN) has been considered a contraindication for SVR owing to a presumed increase in operative risk. However, outcomes in these patients and the impact of SVR on PHTN have not been specifically evaluated. We retrospectively reviewed SVR patients between January 2002 and June 2005. Patients were classified as PHTN (mean pulmonary artery pressure ≥ 25 mm Hg) and no PHTN (mPAP < 25 mm Hg) based on preoperative cardiac catheterization. Cardiac function was assessed using magnetic resonance imaging and echocardiography. Follow-up was 100%. Sixty-nine patients underwent SVR for congestive heart failure. Thirty-six percent (25 of 69) had preoperative PHTN. Preoperatively, PHTN patients had significantly lower ejection fraction (21.1% versus 30.0%; p = 0.005) and larger left ventricular end-systolic volume index (119.0 versus 88.7 mL/m 2; p = 0.04) than patients without PHTN. All PHTN patients and 95.5% (42 of 44) of the no PHTN group were New York Heart Association (NYHA) class III/IV preoperatively. There was 1 operative death in the PHTN group. Surgical ventricular restoration significantly improved cardiac function and pulmonary pressures for PHTN patients. Both groups had similar cardiac function postoperatively. Seventy-two percent (18 of 25) of PHTN patients and 69.0% (29 of 42) of patients without PHTN improved to NYHA class I/II at follow-up. Kaplan-Meier survival of PHTN patients was 68.1% at 3 years, which was lower than patients without PHTN (81.4%; p = 0.44), but not statistically significant. Kaplan-Meier 3-year survival for all SVR patients was 76.6%. Surgical ventricular restoration is a good treatment option in patients with advanced congestive heart failure and PHTN. Our early results are promising and should prompt further studies to confirm these findings.
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Pulmonary hypertension (PHTN) has been considered a contraindication for SVR owing to a presumed increase in operative risk. However, outcomes in these patients and the impact of SVR on PHTN have not been specifically evaluated. We retrospectively reviewed SVR patients between January 2002 and June 2005. Patients were classified as PHTN (mean pulmonary artery pressure ≥ 25 mm Hg) and no PHTN (mPAP &lt; 25 mm Hg) based on preoperative cardiac catheterization. Cardiac function was assessed using magnetic resonance imaging and echocardiography. Follow-up was 100%. Sixty-nine patients underwent SVR for congestive heart failure. Thirty-six percent (25 of 69) had preoperative PHTN. Preoperatively, PHTN patients had significantly lower ejection fraction (21.1% versus 30.0%; p = 0.005) and larger left ventricular end-systolic volume index (119.0 versus 88.7 mL/m 2; p = 0.04) than patients without PHTN. All PHTN patients and 95.5% (42 of 44) of the no PHTN group were New York Heart Association (NYHA) class III/IV preoperatively. There was 1 operative death in the PHTN group. Surgical ventricular restoration significantly improved cardiac function and pulmonary pressures for PHTN patients. Both groups had similar cardiac function postoperatively. Seventy-two percent (18 of 25) of PHTN patients and 69.0% (29 of 42) of patients without PHTN improved to NYHA class I/II at follow-up. Kaplan-Meier survival of PHTN patients was 68.1% at 3 years, which was lower than patients without PHTN (81.4%; p = 0.44), but not statistically significant. Kaplan-Meier 3-year survival for all SVR patients was 76.6%. Surgical ventricular restoration is a good treatment option in patients with advanced congestive heart failure and PHTN. 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Pulmonary hypertension (PHTN) has been considered a contraindication for SVR owing to a presumed increase in operative risk. However, outcomes in these patients and the impact of SVR on PHTN have not been specifically evaluated. We retrospectively reviewed SVR patients between January 2002 and June 2005. Patients were classified as PHTN (mean pulmonary artery pressure ≥ 25 mm Hg) and no PHTN (mPAP &lt; 25 mm Hg) based on preoperative cardiac catheterization. Cardiac function was assessed using magnetic resonance imaging and echocardiography. Follow-up was 100%. Sixty-nine patients underwent SVR for congestive heart failure. Thirty-six percent (25 of 69) had preoperative PHTN. Preoperatively, PHTN patients had significantly lower ejection fraction (21.1% versus 30.0%; p = 0.005) and larger left ventricular end-systolic volume index (119.0 versus 88.7 mL/m 2; p = 0.04) than patients without PHTN. All PHTN patients and 95.5% (42 of 44) of the no PHTN group were New York Heart Association (NYHA) class III/IV preoperatively. There was 1 operative death in the PHTN group. Surgical ventricular restoration significantly improved cardiac function and pulmonary pressures for PHTN patients. Both groups had similar cardiac function postoperatively. Seventy-two percent (18 of 25) of PHTN patients and 69.0% (29 of 42) of patients without PHTN improved to NYHA class I/II at follow-up. Kaplan-Meier survival of PHTN patients was 68.1% at 3 years, which was lower than patients without PHTN (81.4%; p = 0.44), but not statistically significant. Kaplan-Meier 3-year survival for all SVR patients was 76.6%. Surgical ventricular restoration is a good treatment option in patients with advanced congestive heart failure and PHTN. 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subjects Aged
Cardiac Surgical Procedures
Comorbidity
Contraindications
Coronary Artery Bypass - statistics & numerical data
Female
Heart Failure - complications
Heart Failure - surgery
Heart Ventricles - surgery
Humans
Hypertension, Pulmonary - complications
Length of Stay - statistics & numerical data
Male
Middle Aged
Mitral Valve Insufficiency - complications
Mitral Valve Insufficiency - surgery
Postoperative Complications - epidemiology
Proportional Hazards Models
Retrospective Studies
Risk
Stroke Volume
Treatment Outcome
title Surgical Ventricular Restoration for Advanced Congestive Heart Failure: Should Pulmonary Hypertension Be a Contraindication?
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