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J Am Coll Cardiol, 2001; 37:1199-1209 © 2001 by the American College of Cardiology Foundation |
* Norwood Clinic and Kemp-Carraway Heart Institute, Birmingham, Alabama, USA
UCLA Medical Center, Los Angeles, California, USA
Centre Cardio-thoracique de Monaco, Monte Carlo, Monaco
University of Florence, Florence, Italy
|| Cleveland Clinic Foundation, Cleveland, Ohio, USA
Manuscript received June 1, 2000; revised manuscript received November 5, 2000, accepted December 20, 2000.
Reprint requests and correspondence: Dr. Constantine L. Athanasuleas, Department of Cardiac Surgery, Norwood Clinic, 1528 Carraway Boulevard, Birmingham, Alabama 35234
dra{at}norwoodclinic.com
OBJECTIVES
The goal of this study was to evaluate the safety and efficacy of surgical anterior ventricular endocardial restoration (SAVER). The procedure excludes noncontracting segments in the dilated remodeled ventricle after anterior myocardial infarction.
BACKGROUND
Anterior infarction leads to change in ventricular shape and volume. In the absence of reperfusion, dyskinesia develops. Reperfusion by thrombolysis or angioplasty leads to akinesia. Both lead to congestive heart failure by dysfunction of the remote muscle. The akinetic heart rarely undergoes surgical repair.
METHODS
A new international group of cardiologists and surgeons from 11 centers (RESTORE group) investigated the role of SAVER in patients after anterior myocardial infarction. From January 1998 to July 1999, 439 patients underwent operation and were followed for 18 months. Early outcomes of the procedure and risk factors were investigated.
RESULTS
Concomitant procedure included coronary artery bypass grafting in 89%, mitral valve (MV) repair in 22% and MV replacement in 4%. Hospital mortality was 6.6%, and few patients required mechanical support devices such as intraaortic balloon counterpulsation (7.7%), left ventricular assist device (0.5%) or extracorporeal membrane oxygenation (1.3%). Postoperatively, ejection fraction increased from 29 ± 10.4 to 39 ± 12.4%, and left ventricular end systolic volume index decreased from 109 ± 71 to 69 ± 42 ml/m2 (p < 0.005). At 18 months, survival was 89.2%. Time related survival at 18 months was 84% in the overall group and 88% among the 421 patients who had coronary artery bypass grafting or MV repair. Freedom from readmission to hospital for congestive heart failure at 18 months was 85%. Risk factors for death at any time after the operation included older age, MV replacement and lower postoperative ejection fraction.
CONCLUSIONS
Surgical anterior ventricular endocardial restoration is a safe and effective operation in the treatment of the remodeled dilated anterior ventricle after anterior myocardial infarction.
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