Coronary artery bypass grafting with surgical ventricular reconstruction

2021 ◽  
pp. 431-434
Author(s):  
Serenella Castelvecchio ◽  
Raffaella Molfetta ◽  
Andrea Garatti ◽  
Lorenzo Menicanti
Keyword(s):  
Heart Failure ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Ventricular Volume ◽  
Left Ventricular ◽  
Systolic Volume ◽  
Surgical Ventricular Reconstruction ◽  
End Systolic Volume ◽  
Current Management Strategy ◽  
Ventricular Reconstruction

The increase in left ventricular volume after a myocardial infarction is a component of the remodelling process leading to heart failure and it is associated with poor clinical outcomes. Hence, the current management strategy for ischaemic left ventricular dysfunction has been aimed to reverse the remodelling process by medical therapy, devices and/or surgical strategies. Surgical ventricular reconstruction, usually combined with myocardial revascularization, has been introduced as an optional therapeutic strategy aimed to reduce the left ventricle through the exclusion of the scar tissue. Surgical ventricular reconstruction is recommended in selected heart failure patients, especially if a postoperative left ventricular end-systolic volume index less than 70 mL/m2 can be predictably achieved, because a smaller residual volume is associated with improved survival. This chapter briefly discusses the rationale to surgically reverse left ventricular remodelling, the technique, and the indications to the best of the authors’ knowledge, coming from one of the centres with the most experience in SVR worldwide.

scholarly journals Characterizing Heart Failure in the Ventricular Volume Domain

2015 ◽  
Vol 9s1 ◽  
pp. CMC.S18744 ◽  
Author(s):  
Peter L. M. Kerkhof
Keyword(s):  
Heart Failure ◽  
Graphical Representation ◽  
Ventricular Volume ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
End Systolic Volume ◽  
Lv Volume

Heart failure (HF) may be accompanied by considerable alterations of left ventricular (LV) volume, depending on the particular phenotype. Two major types of HF have been identified, although heterogeneity within each category may be considerable. All variants of HF show substantially elevated LV filling pressures, which tend to induce changes in LV size and shape. Yet, one type of HF is characterized by near-normal values for LV end-diastolic volume (EDV) and even a smaller end-systolic volume (ESV) than in matched groups of persons without cardiac disease. Furthermore, accumulating evidence indicates that, both in terms of shape and size, in men and women, the heart reacts differently to adaptive stimuli as well as to certain pharmacological interventions. Adjustments of ESV and EDV such as in HF patients are associated with (reverse) remodeling mechanisms. Therefore, it is logical to analyze HF subtypes in a graphical representation that relates ESV to EDV. Following this route, one may expect that the two major phenotypes of HF are identified as distinct entities localized in different areas of the LV volume domain. The precise coordinates of this position imply unique characteristics in terms of the actual operating point for LV volume regulation. Evidently, ejection fraction (EF; equal to 1 minus the ratio of ESV and EDV) carries little information within the LV volume representation. Thus far, classification of HF is based on information regarding EF combined with EDV. Our analysis shows that ESV in the two HF groups follows different patterns in dependency of EDV. This observation suggests that a superior HF classification system should primarily be founded on information embodied by ESV.

A Systematic Review and Meta-analysis : Safety and Efficacy of Mesenchymal stem Cells Therapy for Heart Failure

2020 ◽  
Vol 15 ◽  
Author(s):  
Tiantian Shen ◽  
Lin Xia ◽  
Wenliang Dong ◽  
Jiaxue Wang ◽  
Feng Su ◽  
...  
Keyword(s):  
Heart Failure ◽  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Safety And Efficacy ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
End Systolic Volume

Background: Preclinical and clinical evidence suggests that mesenchymal stem cells (MSCs) may be beneficial in treating heart failure (HF). However, the effects of stem cell therapy in patients with heart failure is an ongoing debate and the safety and efficacy of MSCs therapy is not well-known. We conducted a systematic review of clinical trials that evaluated the safety and efficacy of MSCs for HF. This study aimed to assess the safety and efficacy of MSCs therapy compared to the placebo in heart failure patients. Methods: We searched PubMed, Embase, Cochrane library systematically, with no language restrictions. Randomized controlled trials(RCTs) assessing the influence of MSCs treatment function controlled with placebo in heart failure were included in this analysis. We included RCTs with data on safety and efficacy in patients with heart failure after mesenchymal stem cell transplantation. Two investigators independently searched the articles, extracted data, and assessed the quality of the included studies. Pooled data was performed using the fixed-effect model or random-effect model when it appropriate by use of Review Manager 5.3. The Cochrane risk of bias tool was used to assess bias of included studies. The primary outcome was safety assessed by death and rehospitalization and the secondary outcome was efficacy which was assessed by six-minute walk distance and left ventricular ejection fraction (LVEF)，left ventricular end-systolic volume（LVESV），left ventricular end-diastolic volume（LVEDV） and brain natriuretic peptide（BNP） Results: A total of twelve studies were included, involving 823 patients who underwent MSCs or placebo treatment. The overall rate of death showed a trend of reduction of 27% (RR [CI]=0.73 [0.49, 1.09], p=0.12) in the MSCs treatment group. The incidence of rehospitalization was reduced by 47% (RR [CI]=0.53[0.38, 0.75], p=0.0004). The patients in the MSCs treatment group realised an average of 117.01m (MD [95% CI]=117.01m [94.87, 139.14], p<0.00001) improvement in 6MWT.MSCs transplantation significantly improved left ventricular ejection fraction (LVEF) by 5.66 % (MD [95% CI]=5.66 [4.39, 6.92], p<0.00001), decreased left ventricular end-systolic volume (LVESV) by 14.75 ml (MD [95% CI]=-14.75 [-16.18, -12.83], p<0.00001 ) and left ventricular end-diastolic volume (LVEDV) by 5.78 ml (MD [95% CI]=-5.78[-12.00, 0.43], p=0.07 ) ,in the MSCs group , BNP was decreased by 133.51 pg/ml MD [95% CI]= -133.51 [-228.17,-38.85], p=0.54, I2= 0.0%) than did in the placebo group. Conclusions: Our results suggested that mesenchymal stem cells as a regenerative therapeutic approach for heart failure is safe and effective by virtue of their self-renewal potential, vast differentiation capacity and immune modulating properties. Allogenic MSCs have superior therapeutic effects and intracoronary injection is the optimum delivery approach. In the tissue origin, patients who received treatment with umbilical cord MSCs seem more effective than bone marrow MSCs. As to dosage injected, (1-10)*10^8 cells were of better effect.

scholarly journals Pulmonary Hypertension in Heart Failure Patients Presenting at OAUTHC, Ile-Ife, Nigeria

2016 ◽  
Vol 10 ◽  
pp. CMC.S38447
Author(s):  
Valentine N. Amadi ◽  
Olufemi E. Ajayi ◽  
Anthony O. Akintomide ◽  
Olugbenga O. Abiodun ◽  
Olaniyi J. Bamikole ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Left Ventricular ◽  
Systolic Volume ◽  
Heart Failure Patients ◽  
Mean Pulmonary Arterial Pressure ◽  
Diastolic Velocity ◽  
End Systolic Volume ◽  
Pulmonary Arterial ◽  
Systolic And Diastolic Function

Background Pulmonary hypertension (PH) is common in heart failure patients. Literature on PH in heart failure is sparse in Nigeria. This study was carried out to determine the prevalence of PH in heart failure patients and ascertain the relationship between left ventricular systolic and diastolic function and the degree of PH. Methods A total of 125 heart failure patients had echocardiography done. PH was diagnosed using tricuspid regurgitation jet and pulmonary ejection jet profile. Results PH was present in 70.4% of heart failure patients. Estimated mean pulmonary arterial pressure increased with increasing severity of systolic and diastolic dysfunction and had significantly negative correlation with ejection fraction, fractional shortening, and early mitral annular tissue diastolic velocity ( E′), but positive correlation with left ventricular end-systolic volume, right ventricular dimension, transmitral E to A ratio, and E/E′ ratio. Conclusion PH is very common in heart failure and has significant relationship with left ventricular function.

scholarly journals The effect of left ventricle ischemia severity on cardiac performance appeared on ejection fraction using radioactive TC 99m MIBI in comparison with echocardiography

2021 ◽  
Vol 2114 (1) ◽  
pp. 012006
Author(s):  
M K Mohammed ◽  
S I Essa
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Mean Value ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
Significant Difference ◽  
End Systolic Volume ◽  
The Mean

Abstract Ischemic heart disease is a major causes of heart failure. Heart failure patients have predominantly left ventricular dysfunction (systolic or diastolic dysfunction, or both). Acute heart failure is most commonly caused by reduced myocardial contractility, and increased LV stiffness. We performed echocardiography and gated SPECT with Tc99m MIBI within 263 patients and 166 normal individuals. Left ventricular end systolic volume (LVESV), left ventricular end diastolic volume (LVEDV), and left ventricular ejection fraction (LVEF) were measured. For all degrees of ischemia, there was a significant difference between ejection fraction values measured by SPECT and echocardiography, and there were no significant differences among end systolic volume and end diastolic volume value calculated by two methods for all cases. The mean value for EDV (ECHO)/EDV (SPECT) was 1.07 ± 0.31 for degree (1, 2); in the degree 3 the mean value was 1.02 ± 0.08, and 1.005 ± 0.07 for degree 4. The mean value for ESV (ECHO)/ESV (SPECT) was 1.08 ± 0.34 for degree (1, 2); while 1.03 ± 0.12, 1.021 ± 0.128 for degree 3 and 4 respectively. This study was showed a good relation between left ventricular size and ejection fraction measured by SPECT with Tc99m, and echocardiography.

Surgical Alternatives for Patients with Heart Failure

1993 ◽  
Vol 4 (2) ◽  
pp. 244-259
Author(s):  
Rita Vargo ◽  
Josephine M. Dimengo
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Ventricular Remodeling ◽  
Artery Bypass ◽  
Treatment Options ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Surgical Interventions ◽  
Cardioverter Defibrillator ◽  
Artery Disease

Chronic heart failure is a progressive syndrome characterized by diffuse coronary artery disease (CAD) or left ventricular failure not amenable to acute interventions of myocardial revascularization. A spectrum of treatment options is available to such patients. Medical therapies consist largely of pharmacologic alternatives and are used in the early stages of heart failure to slow the processes of ventricular remodeling. Surgical interventions are used as adjunctive therapies in the later stages of heart failure. These procedures include coronary endarterectomy, high-risk surgical revascularization, automatic internal cardioverter-defibrillator insertion (Coronary Artery Bypass Grafting in Conjunction with Implantable Cardioverter Defibrillator Trial), cardiac transplantation, and dynamic cardiomyoplasty. This article provides an overview of each of these surgical therapies. Indications for each procedure and patient selection criteria are outlined. A description of each surgical procedure is included. Guidelines for postoperative nursing care are provided, and postoperative complications are discussed

scholarly journals Left Ventricular End-Systolic Volume Is a Reliable Predictor of New-Onset Heart Failure with Preserved Left Ventricular Ejection Fraction

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Marina Kato ◽  
Shuichi Kitada ◽  
Yu Kawada ◽  
Kosuke Nakasuka ◽  
Shohei Kikuchi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Adverse Events ◽  
Ejection Fraction ◽  
Prognostic Indicator ◽  
Left Ventricular ◽  
Volume Index ◽  
Univariable Analysis ◽  
Systolic Volume ◽  
End Systolic Volume

Background. Left ventricular (LV) ejection fraction (EF) and LV volumes were reported to have prognostic efficacy in cardiac diseases. In particular, the end-systolic volume index (LVESVI) has been featured as the most reliable prognostic indicator. However, such efficacy in patients with LVEF ≥ 50% has not been elucidated. Methods. We screened the patients who received cardiac catheterization to evaluate coronary artery disease concomitantly with both left ventriculography and LV pressure recording using a catheter-tipped micromanometer and finally enrolled 355 patients with LVEF ≥ 50% and no history of heart failure (HF) after exclusion of the patients with severe coronary artery stenosis requiring early revascularization. Cardiovascular death or hospitalization for HF was defined as adverse events. The prognostic value of LVESVI was investigated using a Cox proportional hazards model. Results. A univariable analysis demonstrated that age, log BNP level, tau, peak − dP/dt, LVEF, LV end-diastolic volume index (LVEDVI), and LVESVI were associated with adverse events. A correlation analysis revealed that LVESVI was significantly associated with log BNP level (r = 0.356, p<0.001), +dP/dt (r = −0.324, p<0.001), −dP/dt (r = 0.391, p<0.001), and tau (r = 0.337, p<0.001). Multivariable analysis with a stepwise procedure using the variables with statistical significance in the univariable analysis revealed that aging, an increase in BNP level, and enlargement of LVESVI were significant prognostic indicators (age: HR: 1.071, 95% CI: 1.009–1.137, p=0.024; log BNP : HR : 1.533, 95% CI: 1.090–2.156, p=0.014; LVESVI : HR : 1.051, 95% CI: 1.011–1.093, p=0.013, respectively). According to the receiver-operating characteristic curve analysis for adverse events, log BNP level of 3.23 pg/ml (BNP level: 25.3 pg/ml) and an LVESVI of 24.1 ml/m2 were optimal cutoff values (BNP : AUC : 0.753, p<0.001, LVESVI : AUC : 0.729, p<0.001, respectively). Conclusion. In patients with LVEF ≥ 50%, an increased LVESVI is related to the adverse events. LV contractile performance even in the range of preserved LVEF should be considered as a role of a prognostic indicator.

scholarly journals Miokardo gyvybingumas – svarbus požymis numatant chirurginį išeminio širdies nepakankamumo gydymą

2007 ◽  
Vol 5 (3) ◽  
pp. 0-0
Author(s):  
Elvyra Voluckienė ◽  
Loreta Ivaškevičienė ◽  
Virginija Grabauskienė ◽  
Jurgita Židanavičiūtė ◽  
Giedrius Uždavinys
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Ischemic Heart Failure ◽  
Surgical Ventricular Reconstruction ◽  
Ventricular Reconstruction ◽  
The Mean ◽  
Vilnius University ◽  
One Year

Elvyra Voluckienė1, Loreta Ivaškevičienė2, Virginija Grabauskienė3, Jurgita Židanavičiūtė4, Giedrius Uždavinys21 Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centras,Santariškių g. 2, LT-08661 Vilnius2 Vilniaus universiteto Širdies chirurgijos centras, Santariškių g. 2, LT-08661 Vilnius3 Vilniaus universiteto Kardiologijos ir angiologijos centras4 Vilniaus Gedimino technikos universitetasEl paštas: [email protected] Tikslas Nustatyti priešoperacinės kairiojo skilvelio (KS) funkcijos prognostinę reikšmę pacientams, sergantiems sunkiu išeminiu širdies nepakankamumu (IŠN), po chirurginės kairiojo skilvelio rekonstrukcijos (KSR) ir aortos bei vainikinių jungčių (AVJ) suformavimo operacijos. Ligoniai ir metodai Retrospektyvinei analizei tikslingai atrinkti 37 pacientai (32 vyrai, vidutinis amžius 59 ± 10,5 m.), sergantys IŠN ir KS išvarymo frakcija (IF) < 30%, kuriems buvo atlikta KSR ir AVJ suformavimo operacija. Po persirgto Q bangos priekinio miokardo infarkto buvo praėję vidutiniškai 5,8 ± 3,3 mėnesio. Vidutinė NYHA klasė buvo 3,4 ± 1,3. KS funkcijos rodikliai buvo apskaičiuoti dobutamino echokardiografijos tyrimo ramybės (r) ir mažos dobutamino dozės (mdd) metu: diastolinio skersmens indeksas – DDI cm/m² (r), IF (%) (r), sienos judėjimo indeksas – SJIr ir SJImdd, asinergijos plotas (Aproc.) (mdd). Hospitalinis mirštamumas buvo 13,5%; mirštamumas per vienus metus buvo 6,25%. Vidutinė NYHA klasė po vienų metų buvo 2,2 ± 1,1. Rezultatai Logistinės regresijos analizė ir „Proportional Odds“ modelis parodė, kad priešoperacinis KS Aproc. (mdd) buvo statistiškai reikšmingas prognostinis pooperacinės vienų metų NYHA klasės požymis (OR 0,86, p = 0,0086). Išvada Priešoperacinis kairiojo skilvelio asinergijos dydis, nustatytas dobutamino echokardiografijos tyrimo metu, yra svarbus požymis, numatant pooperacinę vienų metų NYHA klasę pacientams, sergantiems sunkiu išeminiu širdies nepakankamumu po chirurginės kairiojo skilvelio rekonstrukcijos ir aortos bei vainikinių jungčių suformavimo operacijos. Pagrindiniai žodžiai: išeminis širdies nepakankamumas, kairiojo skilvelio rekonstrukcija Myocardial viability predicts improvement in patients after surgical treatment of ischemic heart failure Elvyra Voluckienė1, Loreta Ivaškevičienė2, Virginija Grabauskienė3, Jurgita Židanavičiūtė4, Giedrius Uždavinys21 Vilnius University Hospital Santariškių Clinics, Cardial Surgery Centre,Santariškių str. 2, LT-08661 Vilnius, Lithuania2 Vilnius University, Cardiac Surgery Centre, Santariškių str. 2, LT-08661 Vilnius, Lithuania3 Vilnius University, Centre of Cardiology and Angiology4 Vilnius Gediminas Technical UniversityE-mail: [email protected] Objective This study sought to define the prognostic value of myocardial viability in patients with severe ischemic heart failure, who underwent surgical ventricular reconstruction with associated coronary grafting. Patients and methods This retrospective study selected 37 consecutive patients (32 men, mean age 59 ± 10.5 years) who underwent surgical ventricular reconstruction with associated coronary grafting, and preoperative left ventricular (LV) ejection fraction < 30% (mean, 25 ± 4.6%). The mean New York Heart Association (NYHA) class before operation was 3.4 ± 1.3. The time-frame of the large anterior myocardial infarction was 5.8 ± 3.3 months. LV systolic function was assessed by echo-dobutamine: the wall motion score index at rest (WMSIr), WMSI and the extent of LV asynergy (A%) during low-dose dobutamine (ldd). In-hospital mortality was 13.5%. After one-year, the mean functional NYHA class was 2.2 ± 1.1, and at one-year the mortality was 6.25%. Results Logistic regression analysis and the Proportional Odds model showed that LV A% during ldd (OR 0.86, p = 0.0086) was an independent predictor for the one-year postoperative functional NYHA class. Conclusions The preoperative extent of left ventricular asynergy during echo-dobutamine can predict the expectation of functional NYHA class improvement in patients with a severe ischemic heart failure one-year following surgical ventricular reconstruction with associated coronary grafting. Key words: ischemic heart failure, surgical ventricular reconstruction

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