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 Early Results After Coronary Artery Bypass Grafting in Patients With Severe Ischemic Left Ventricular Dysfunction

2020 ◽  
Vol 9 (3) ◽  
pp. 377-382
Author(s):  
M. K. Mazanov ◽  
P. V. Chernyavsky ◽  
M. A. Sagirov ◽  
N. M. Bikbova ◽  
N. I. Kharitonova ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Bypass Grafting ◽  
Artery Disease

Introduction. The number of patients with severe ischemic left ventricular dysfunction (ILVD), who undergo coronary artery bypass, increasing each year. ILVD is an established risk factor for mortality in patients after myocardial revascularization during the early and late postoperative periods.Aim of study. To evaluate the early results of surgical myocardial revascularization in patients with coronary artery disease (CAD) and severe ILVD.Material and methods. The study included 149 patients with coronary artery disease with severe left ventricular dysfunction (ejection fraction (EF) ≤39%), operated from January 2002 to December 2018. different variables were assessed (pre- and postoperative), including LV ejection fraction and end systolic volume index (ESVI).Results. The average age of the patients was 59.36±8.97 years (from 30 to 78 years), 93% of the patients were men. In 28 patients (19%), ILVD developed against the background of myocardial infarction (MI) and in 121 (81%) due to ischemic cardiomyopathy (ICMP) with a history of myocardial infarction. The mean EF before surgery was 36.64±3.17 (from 21 to 39%). In the postoperative period, there was an increase in EF, which averaged 44.92±4.92 (from 36 to 59%) (p value <0.001). The mean LV ESVI before surgery was 60.23±11.52 ml/m2. In the immediate postoperative period ESVI decreased to 46.26±12.40 ml/m2 (the value of p<0.001). The average number of bypass coronary arteries in one patient was 3.9±0.87. There was also a decrease in the degree of mitral regurgitation in most patients after coronary artery bypass grafting (CABG) (p value <0.001). Hospital mortality was 2% (3 patients).Conclusion. Coronary artery bypass grafting in patients with severe ischemic left ventricular dysfunction can be performed with low mortality. Surgical myocardial revascularization can be considered a safe and effective operation for patients with coronary artery disease with a satisfactory condition of the distal coronary arteries, low ejection fraction, and with a predominance of viable myocardium.

scholarly journals The possibilities of using levosimendan in medical preparation to Coronary Artery Bypass Grafting in coronary artery disease patients with low left ventricular ejection fraction

2020 ◽  
Vol 92 (1) ◽  
pp. 43-48
Author(s):  
V P Gazizova ◽  
E E Vlasova ◽  
E V Dzybinskaya ◽  
V V Gramovich ◽  
O V Stukalova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Early Postoperative Period ◽  
Left Ventricular Ejection ◽  
Drug Preparation ◽  
Ventricular Ejection Fraction ◽  
Artery Disease

Aim: to work out an approach of preoperative drug preparation for CAD patients with low LVEF and varying degrees of compensation for CHF, to study the possibility of using levosimendan (L) in this preparation. Materials and methods. We studied 82 patients with severe angina pectoris, multivascular coronary disease, extensive postinfarction zone, LVEF ≤35%, chronic heart failure and proven viable myocardium, which performed CABG. All patients received long - term standard CHF therapy before surgery: loop diuretic, ACE/ARA, beta - blocker, aldosterone antagonist. In the first, retrospective part of the study (39 pts), it was determined which factors could be associated with perioperative AHF. In the second, prospective part (43 pts), the course of the operation and the early postoperative period in patients with compensated and uncompensated heart failure were compared; uncompensated pts received L 2 days before surgery in addition to standard therapy. The third, retro - prospective part of the study (37 pts) was the assessment of operation outcome in patients only with uncompensated pre - operative CHF, but with different preoperative drug preparation. Results. Statistically significant direct influence on the perioperative AHF development was provided by the combined clinical sign - venous pulmonary congestion+orthopnea (p

scholarly journals Miokardo perfuzijos normalizavimosi po miokardo revaskulizacijos prognozavimas atliekant širdies radionuklidinius tyrimus su nitratais

2007 ◽  
Vol 5 (3) ◽  
pp. 0-0
Author(s):  
Antanas Mačys ◽  
Ilona Kulakienė ◽  
Šarūnas Kinduris
Keyword(s):  
Coronary Artery ◽  
Myocardial Perfusion ◽  
Wall Motion ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Wall Thickening ◽  
Gated Spet ◽  
Artery Disease

Antanas Mačys1, Ilona Kulakienė2, Šarūnas Kinduris31 Kauno medicinos universiteto klinikų Širdies, krūtinės ir kraujagyslių chirurgijos klinika,Eivenių g. 2, LT-50009 Kaunas2 Kauno medicinos universiteto klinikų Radiologijos klinika, Kaunas3 Kauno medicinos universiteto Biomedicininių tyrimų institutas,Eivenių g. 4, LT-50009 KaunasEl paštas: [email protected] Įvadas / tikslas Miokardo gyvybingumo vertinimas atliekant širdies radionuklidinius tyrimus su nitratais išlieka nevienareikšmis. Šio darbo tikslas buvo įvertinti priešoperacinį gyvybingą miokardą ir prognozuoti miokardo perfuzijos normalizavimąsi po chirurginės revaskulizacijos radionuklidinės kompiuterinės tomografijos (RKT) su nitratais metodu ligoniams, sergantiems pažengusia išemine širdies liga (IŠL). Ligoniai ir metodai Dvidešimt dviem ligoniams (19 vyrų, 3 moterys; amžiaus vidurkis 63,5 ± 8,8 metai), sergantiems stabiliąja IŠL su sutrikusia kairiojo skilvelio funkcija (vidutinė kairiojo skilvelio išstūmimo frakcija (KS IF) 32,7 ± 11,6%, vidutinis sienelių judėjimo indeksas 1,80 ± 0,54), buvo atliktas širdies RKT tyrimas su 99mTc-MIBI ramybėje ir ramybėje su nitratais (0,5 mg nitroglicerino tabletė po liežuviu) prieš vainikinių jungčių suformavimo operaciją (VJSO) bei ramybėje praėjus 3 ir 6 mėnesiams po jos. Rezultatai VJSO metu 20 ligonių (90,9%) atlikta visiškoji miokardo revaskulizacija. Operacijuojant vienam ligoniui suformuotos vidutiniškai 2,8 ± 0,9 distalinės jungtys. Prieš operaciją suminis ramybės rodmuo (SRR) buvo 20,0 ± 11,3, o suminis ramybės su nitratais rodmuo (SRnR) – 16,81 ± 1,1, raumens sustorėjimas (RS) – 16,1 ± 8,6, sienelės judesys (SJ) – 16 ± 9,1 bei KS IF – 32,7 ± 11,6%. Prognozavome, kad po operacijos SRR bus toks pat, kaip ir prieš operaciją nustatytas SRnR, tačiau pooperacinis SRR po 3 mėnesių buvo 14,6 ± 10,8, o po 6 mėnesių – 13,9 ± 11,0. Taigi, ###Delta(gr)SRR po 3 mėnesių pagerėjo 1,69 karto (###Delta(gr)SRR 5,4 ± 7,8), o po 6 mėnesių – 1,91 karto (###Delta(gr)SRR 6,1 ± 6,9) labiau, negu prognozavome. Norėdami tiksliau prognozuoti pooperacinį miokardo perfuzijos normalizavimąsi, naudojome tiesinės regresijos metodą ir sudarėme tiesinės regresijos lygtį: priešop. SRR = 24,197 – 0,345 × amžius + 0,689 × SRnR (determinacijos koeficientas R2 = 0,707). Pooperaciniu laikotarpiu RS ir SJ statistiškai reikšmingai sumažėjo, t. y. kontrakcija pagerėjo, tiek po 3, tiek po 6 mėnesių (RS – 13,4 ± 8,3 ir 13,7 ± 9,1; SJ – 13,4 ± 8,1 ir 13 ± 8,7), tačiau KS IF padidėjimas nebuvo statistiškai reikšmingas (nuo 32,7 ± 11,6% iki 34,2 ± 14,1% ir 35,4 ± 15,4%). Išvados Miokardo radionuklidinė kompiuterinė tomografija su nitratais naudojant tiesinės regresijos metodą leidžia tiksliai prognozuoti miokardo perfuzijos normalizavimąsi po chirurginės revaskulizacijos. Pagrindiniai žodžiai: išeminė širdies liga, vainikinių jungčių suformavimo operacija, radionuklidinė kompiuterinė tomografija Evaluation of left ventricle ejection fraction impact on cardiac surgery risk stratification by EuroSCORE system Antanas Mačys1, Ilona Kulakienė2, Šarūnas Kinduris31 Kaunas University of Medicine Hospital, Department of Cardiothoracic and Vascular Surgery,Eivenių str. 2, LT-50009 Kaunas, Lithuania2 Kaunas Medical University Hospital, Clinic of Radiology, Kaunas, Lithuania3 Kaunas University of Medicine, Institute for Biomedical Research,Eivenių str. 4, LT-50009 Kaunas, LithuaniaE-mail: [email protected] Background / objective Nitrate-augmented imaging in the evaluation of myocardial viability still remains controversial. The aim of this study was to predict postoperative myocardial perfusion recovery after coronary artery bypass grafting (CABG) using nitrate-enhanced myocardial perfusion SPET in patients with coronary artery disease and severe left ventricular dysfunction. Patients and methods Twenty-two patients (19 male, 3 female; mean age 63.5 ± 8.8 years) with ischaemic cardiomyopathy (left ventricular ejection fraction (LVEF) 32.7 ± 11.6%; wall motion index 1.80 ± 0.54) were referred to baseline-nitrate Sestamibi gated-SPET both before CABG and at 3 and 6-month follow-up. Acquisitions were recorded at baseline after rest-injection of 450–550 MBq of Sestamibi and repeated under nitrates (0.5 mg of nitroglycerin sublingually). Results Twenty patients (90.9%) had complete myocardial revascularization. The mean number of distal anastomoses was 2.8 ± 0.9. Preoperative perfusion summed rest score (SRS) was 20.0 ± 11.3 and summed nitrate enhanced rest score (SRnS) was 16.8 ± 11.1, wall thickening (WT) 16.1 ± 8.6, wall motion (WM) 16 ± 9.1 and LVEF 32.7 ± 11.6%. Post surgery SRS was expected to be of the same value as SRnS and postoperative perfusion improvement score (###Delta(gr)SRS) to be 3.2 ± 3.7. But postoperative SRS proved to be 14.6 ± 10.8 at a 3-month follow-up and 13.9 ± 11.0 at 6-month follow-up. ###Delta(gr)SRS was 1.69 times (###Delta(gr)SRS 5.4 ± 7.8) at 3-month and 1.91 times (###Delta(gr)SRS 6.1 ± 6.9) at 6-month follow up higher than predicted. In order to predict postoperative myocardial perfusion recovery more precisely, the method of linear regression was used with the following regression equation: postop. SRS = 24.197 – 0.345 × age + 0.689 × SRnS (coefficient of determination R2 = 0.707). A significant improvement of regional wall thickening and wall motion were detected at 3 and 6-month follow up (WT = 13.4 ± 8.3 and 13.7 ± 9.1; WM = 13.4 ± 8.1 and 13 ± 8.7). But LVEF improvement was not statistically significant (from 32.7 ± 11.6% to 34.2 ± 14.1% and 35.4 ± 15.4%). Conclusions Nitrate-augmented gated-SPET data combined with a linear regression equation allow a precise prediction of myocardial perfusion recovery after myocardial revascularization. Key words: coronary artery disease, coronary artery bypass grafting, single-photon emission tomography

scholarly journals Echocardiographic parameters of left ventricular non-systolic function predict length of stay following coronary artery bypass graft -- a prospective observational study

2021 ◽  
Author(s):  
samhati Mondal ◽  
Nauder Faraday ◽  
Weidong Gao ◽  
Sarabdeep Singh ◽  
Sachidanand Hebbar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Hospital Stay ◽  
Coronary Artery Bypass ◽  
Prospective Observational Study ◽  
Systolic Function ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Echocardiographic Parameters ◽  
Systolic Phase

Background: Abnormal left ventricular (LV) echocardiographic parameters during non-systolic phase, with or without a diagnosis of heart failure, is a common finding that can be easily diagnosed by intra-operative transesophageal echocardiography (TEE). However, its association with duration of hospital stay after coronary artery bypass (CAB) is unknown. Objective: To determine if Abnormal left ventricular (LV) echocardiographic parameters during non-systolic phase is associated with length of hospital stay after coronary artery bypass surgery (CAB). Method: Prospective observational study at a single tertiary academic medical center Result: Median time to hospital discharge was significantly longer for subjects with abnormal left ventricular (LV) echocardiographic parameters during non-systolic phase (9.1/IQR 6.6-13.5 days) than those with normal LV non-systolic function (6.5/IAR 5.3-9.7days) (P< 0.001). The probability of hospital discharge was 34% lower (HR 0.66/95% CI 0.47-0.93) for subjects with abnormal LV function even during non-systole despite a normal LV systolic function, independent of potential confounders, including a baseline diagnosis of heart failure Conclusions and Relevance: In patients with normal systolic function undergoing CAB, non-systolic LV dysfunction is associated with prolonged duration of postoperative hospital stay. This association cannot be explained by baseline comorbidities or common post-operative complications.

scholarly journals FREQUENCY OF CORONARY ARTERY DISEASE IN VALVULAR AORTIC STENOSIS :EXPERIENCE OF THE CARDIOLOGY CENTER OF MOHAMED V MILITARY HOSPITAL ABOUT 148 CASES

2021 ◽  
Vol 9 (08) ◽  
pp. 487-491
Author(s):  
D. Massimbo ◽  
S. Nikiema ◽  
S. Ahchouch ◽  
I. Asfalou ◽  
A. Benyass
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Aortic Stenosis ◽  
Coronary Disease ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Military Hospital ◽  
Ventricular Ejection Fraction ◽  
Artery Disease

Introduction: The risk factors for aortic stenosis have been shown to be similar to those for atherosclerosis. Thus, coronary disease is often found simultaneously in patients with aortic stenosis. Our work aims to determine the frequency of coronary disease in a Moroccan population with aortic stenosis while recalling the causes and the prognostic and therapeutic impacts of this association. Materials and Methods: This is a retrospective study of 148 patients hospitalized at the cardiology center of the military hospital of Rabat over a period of 24 months, during which we analyzed clinical, electrocardiographic, echocardiographic and coronarographic data of the patients in order to evaluate the coronary involvement during aortic stenosis. Results: The mean age of the population was 65 [57, 74] years, the sex ratio was 1.21. Smoking reported in 38.5% of patients was the main modifiable cardiovascular risk factor, followed by hypertension in 35.8% of patients. Dyspnea on exertion was the most frequent reason for consultation at 81%, 64% of which were at least NYHA functional class III, followed by angina, which represented 33% of the series. The aortic stenosis was tight in the majority (mean SAo: 0.8 cm²) and the left ventricular ejection fraction was preserved overall. Coronary artery disease was associated with aortic stenosis in 24% of cases, with predominantly monotruncal involvement (53%) followed by tritruncal involvement (30%). 21.6% of these patients underwent coronary artery bypass grafting concomitantly with surgical replacement of the aortic valve. Conclusion: The incidence of coronary artery disease associated with aortic stenosis is variable according to age. It is higher in European series because of aging. In our relatively younger population, it is lower but not negligible.

Coronary revascularisation in patients with ischaemic cardiomyopathy

Heart ◽  
2021 ◽  
pp. heartjnl-2020-316856
Author(s):  
Matthew Ryan ◽  
Holly Morgan ◽  
Mark C Petrie ◽  
Divaka Perera
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Controlled Trial ◽  
Artery Bypass ◽  
Stable Coronary Artery Disease ◽  
Coronary Intervention ◽  
Ischaemic Cardiomyopathy ◽  
Artery Disease ◽  
Stich Trial ◽  
Randomised Controlled

Heart failure resulting from ischaemic heart disease is associated with a poor prognosis despite optimal medical treatment. Despite this, patients with ischaemic cardiomyopathy have been largely excluded from randomised trials of revascularisation in stable coronary artery disease. Revascularisation has multiple potential mechanisms of benefit, including the reversal of myocardial hibernation, suppression of ventricular arrhythmias and prevention of spontaneous myocardial infarction. Coronary artery bypass grafting is considered the first-line mode of revascularisation in these patients; however, evidence from the Surgical Treatment of Ischaemic Heart Failure (STICH) trial showed a reduction in mortality, though this only became apparent with extended follow-up due to an excess of early adverse events in the surgical arm. There is currently no randomised controlled trial evidence for percutaneous coronary intervention in patients with ischaemic cardiomyopathy; however, the REVIVED-BCIS2 trial has recently completed recruitment and will address this gap in the evidence. Future directions include (1) clinical trials of revascularisation in patients hospitalised with heart failure, (2) defining the role of viability and ischaemia testing in heart failure, (3) studies to enhance the understanding of the mechanistic effects of revascularisation and (4) generating models to refine pre- and post-revascularisation risk prediction.

Myocardial revascularization: symptomatic and prognostic indications

ESC CardioMed ◽  
2018 ◽  
pp. 1393-1395
Author(s):  
Jean-Claude Tardif ◽  
Philippe L. L’Allier ◽  
Fabien Picard
Keyword(s):  
Coronary Artery ◽  
Medical Therapy ◽  
Coronary Revascularization ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Optimal Medical Therapy ◽  
Left Ventricular Ejection ◽  
Major Adverse Cardiovascular Events ◽  
Large Area ◽  
Artery Disease

The primary goal of therapy in patients with chronic ischaemic heart disease is to relieve symptoms, delay or prevent progression of coronary artery disease, and decrease the risk of major adverse cardiovascular events. This is primarily achieved with optimal medical therapy. When coronary revascularization is considered, symptomatic and prognostic indications must be differentiated. For symptomatic indications, revascularization is justified if there is a large area of inducible ischaemia or if there is persistent limiting angina despite optimal medical therapy. The key prognostic indications for revascularization are left main disease with stenosis greater than 50%, any proximal left anterior descending artery stenosis greater than 50%, two-vessel or three-vessel disease with stenosis greater than 50% with impaired left ventricular function (left ventricular ejection fraction <40%), a large area of ischaemia (>10% of the left ventricle), or a single remaining patent coronary artery with stenosis greater than 50%.

Sign in / Sign up

Export Citation Format

Share Document