589: New York Heart Association Functional Class Correlates Poorly with Peak Oxygen Consumption during Cardiopulmonary Exercise Tolerance Testing: Implications for Orthotopic Heart Transplantation

Objective Aortic valve replacement is the standard of care for severe, symptomatic aortic valve stenosis (AS); however, anatomy or preexisting comorbidities may preclude conventional or alternative transcatheter approaches. Aortic valve bypass (AVB) may be performed as a salvage procedure for the relief of symptomatic aortic stenosis in patients who are not suitable candidates for aortic valve replacement. Methods At our institution, seven patients underwent AVB using the Correx automated coring and apical connector system. All patients had severe AS with New York Heart Association functional class 3 symptoms and were not candidates for conventional or transcatheter approaches. Via a left anterolateral thoracotomy to access the descending aorta and left ventricular apex, we used the Correx system (Correx, Waltham, MA USA) to anastomose a valve conduit to the left ventricular apex proximally and the descending aorta distally. Three patients required cardiopulmonary bypass. Results In all seven patients, the automated coring and apical connector was successfully deployed. There were two in-hospital deaths in this series. Immediately postoperatively and at 3 months, there was a significant reduction in mean and peak valve gradients, and all surviving patients performed at New York Heart Association functional class 1. Conclusions Aortic valve bypass seems to be an acceptable alternative for the treatment of severe AS in high-risk patients who are not candidates for aortic valve replacement. The Correx automated system may improve the clinical applicability and surgical repro-ducibility of AVB in appropriately selected patients in which conventional or transcatheter aortic valve replacement is not a feasible options.

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Correlation of the New York Heart Association classification and the cardiopulmonary exercise test: A systematic review

International Journal of Cardiology ◽

10.1016/j.ijcard.2018.04.021 ◽

2018 ◽

Vol 263 ◽

pp. 88-93 ◽

Cited By ~ 6

Author(s):

Fang Yi Lim ◽

Jonathan Yap ◽

Fei Gao ◽

Ling Li Teo ◽

Carolyn S.P. Lam ◽

...

Keyword(s):

Systematic Review ◽

New York ◽

Exercise Test ◽

Heart Association ◽

Cardiopulmonary Exercise Test ◽

Cardiopulmonary Exercise ◽

New York Heart Association

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Subtotal Pericardiectomy via Sternotomy for Constrictive Pericarditis

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230000800210 ◽

2000 ◽

Vol 8 (2) ◽

pp. 134-136 ◽

Cited By ~ 1

Author(s):

Ashok K Srivastava ◽

Anoop K Ganjoo ◽

Bashist Misra ◽

Tapas Chaterjee ◽

Aditya Kapoor ◽

...

Keyword(s):

New York ◽

Constrictive Pericarditis ◽

Left Atrial ◽

Heart Association ◽

Functional Class ◽

Left Atrial Size ◽

Univariate Logistic Regression Analysis ◽

Atrial Size ◽

New York Heart Association ◽

Pericardial Calcification

Records of 103 patients with constrictive pericarditis who underwent subtotal pericardiectomy from January 1990 to December 1997 were retrospectively analyzed. The etiology of pericardial constriction was unknown in 63, tuberculous in 30, pyogenic in 7, and miscellaneous in 3 patients. Adequate pericardiectomy could be accomplished in 85 (82.5%) patients. Eleven patients (10.68%) died within 30 days of surgery. The 92 survivors were followed up for 47.21 ± 30.7 months; functional status improved in all cases. Of 15 variables examined by univariate logistic regression analysis, preoperative New York Heart Association functional class IV, atrial fibrillation, left atrial size > 40 mm·m−2, mild to moderate mitral regurgitation, tricuspid regurgitation, pericardial calcification, and inadequate pericardiectomy were found to be significant predictors of poor outcome. Adequate pericardiectomy via sternotomy was considered to carry low operative risk and provide excellent improvement in functional capacity.

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Real-Time Three-Dimensional Echocardiographic Study of Left Ventricular Function After Infarct Exclusion Surgery for Ischemic Cardiomyopathy

Circulation ◽

10.1161/circ.102.suppl_3.iii-101 ◽

2000 ◽

Vol 102 (suppl_3) ◽

Author(s):

Jian Xin Qin ◽

Takahiro Shiota ◽

Patrick M. McCarthy ◽

Michael S. Firstenberg ◽

Neil L. Greenberg ◽

...

Keyword(s):

New York ◽

Ischemic Cardiomyopathy ◽

Heart Association ◽

Left Ventricular ◽

Functional Class ◽

Before And After ◽

Infarct Exclusion ◽

New York Heart Association ◽

Lv Volume

Background —Infarct exclusion (IE) surgery, a technique of left ventricular (LV) reconstruction for dyskinetic or akinetic LV segments in patients with ischemic cardiomyopathy, requires accurate volume quantification to determine the impact of surgery due to complicated geometric changes. Methods and Results —Thirty patients who underwent IE (mean age 61±8 years, 73% men) had epicardial real-time 3-dimensional echocardiographic (RT3DE) studies performed before and after IE. RT3DE follow-up was performed transthoracically 42±67 days after surgery in 22 patients. Repeated measures ANOVA was used to compare the values before and after IE surgery and at follow-up. Significant decreases in LV end-diastolic (EDVI) and end-systolic (ESVI) volume indices were apparent immediately after IE and in follow-up (EDVI 99±40, 67±26, and 71±31 mL/m 2 , respectively; ESVI 72±37, 40±21, and 42±22 mL/m 2 , respectively; P <0.05). LV ejection fraction increased significantly and remained higher (0.29±0.11, 0.43±0.13, and 0.42±0.09, respectively, P <0.05). Forward stroke volume in 16 patients with preoperative mitral regurgitation significantly improved after IE and in follow-up (22±12, 53±24, and 58±21 mL, respectively, P <0.005). New York Heart Association functional class at an average 285±144 days of clinical follow-up significantly improved from 3.0±0.8 to 1.8±0.8 ( P <0.0001). Smaller end-diastolic and end-systolic volumes measured with RT3DE immediately after IE were closely related to improvement in New York Heart Association functional class at clinical follow-up (Spearman’s ρ=0.58 and 0.60, respectively). Conclusions —RT3DE can be used to quantitatively assess changes in LV volume and function after complicated LV reconstruction. Decreased LV volume and increased ejection fraction imply a reduction in LV wall stress after IE surgery and are predictive of symptomatic improvement.

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Cavo-pulmonary anastomosis excluding the portal venous return: an alternative for patients with protein-losing enteropathy secondary to the Fontan procedure

Cardiology in the Young ◽

10.1017/s1047951100006120 ◽

1998 ◽

Vol 8 (2) ◽

pp. 221-227 ◽

Cited By ~ 1

Author(s):

Miguel Barbero-Marcial ◽

Arlindo Riso ◽

Edmar Atik ◽

Carla Tanamati ◽

Humberto Reis ◽

...

Keyword(s):

New York ◽

Fontan Procedure ◽

Heart Association ◽

Functional Class ◽

Caval Vein ◽

Venous Flow ◽

Protein Losing Enteropathy ◽

Right Pulmonary Artery ◽

New York Heart Association ◽

The Right

AbstractSevere protein losing enteropathy occurred in 3 of our 128 patients undergoing the Fontan procedure in the period of 1982 to 1994. The complication occurred 4, 4.5 and 5 years after the procedure, respectively. One patient had double inlet left ventricle while the other two had tricuspid atresia. All had initially undergone an atrio-pulmonary connection, and the duration of the enteropathy was 12, 13,5 and 15 months. All patients were in functional class IV of the New York Heart Association. The presence of protein losing enteropathy was confirmed by determining levels of fecal alfa-1 antitrypsin, enteric clearance of 51 Cromo labeled albumin, and endoscopy with histopathological study of the small bowel.They underwent further surgery to convert the atrio-pulmonary to a cavo-pulmonary anastomosis which excluded all the hepatic veins. A bovine pericardial baffle was sutured in the inferior caval vein so as to leave the hepatic venous flow draining to the right atrium and thence through an atrial septal defect to the left atrium and systemic circulation. The inferior caval venous flow was directed through an intra-atrial tunnel to the right pulmonary artery, and the superior caval vein was anastomosed to the superior aspect of the right pulmonary artery, thus completing the total cavo-pulmonary anastomosis with exclusion of the portal venous flow.Postoperatively, there was total regression of the clinical and laboratory findings. All patients are now in functional class I or II of the New York Heart Association. They have mild to moderate cyanosis up to three and a half years from the reoperation. We recommend the technique as an alternative for patients with severe protein losing enteropathy occurring after the Fontan procedure.

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