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J Am Coll Cardiol, 2004; 44:1439-1445, doi:10.1016/j.jacc.2004.07.017
© 2004 by the American College of Cardiology Foundation
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HEART FAILURE

Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation

Constantine L. Athanasuleas, MD*, Gerald D. Buckberg, MD{dagger},*, Alfred W.H. Stanley, MD*, William Siler, PhD*, Vincent Dor, MD{ddagger}, Marisa Di Donato, MD§, Lorenzo Menicanti, MD||, Sergio Almeida de Oliveira, MD, Friedhelm Beyersdorf, MD#, Irving L. Kron, MD**, Hisayoshi Suma, MD{dagger}{dagger}, Nicholas T. Kouchoukos, MD{ddagger}{ddagger}, Wistar Moore, MD§§, Patrick M. McCarthy, MD||||, Mehmet C. Oz, MD¶¶, Francis Fontan, MD##, Meredith L. Scott, MD§§, Kevin A. Accola, MD§§ RESTORE Group

* Norwood Clinic and Kemp Carraway Heart Institute, Birmingham, Alabama
{dagger} UCLA Medical Center, Los Angeles, California
{ddagger} Centre Cardio-thoracique de Monaco, Monte Carlo, Monaco
§ University of Florence, Florence, Italy
|| Ospedale Clinicizzato San Donato, Milan, Italy
University of Sao Paulo, Sao Paulo, Brazil
# Albert-Ludwigs-Universitat Freiburg, Freiburg, Germany
** University of Virginia, Charlottesville, Virginia
{dagger}{dagger} Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
{ddagger}{ddagger} Missouri Baptist Hospital, St. Louis, Missouri
§§ Orlando Heart Surgery Group, Orlando, Florida
|||| The Cleveland Clinic Foundation, Cleveland, Ohio
¶¶ Columbia University, New York, New York
## St. Augustine Hospital, Bordeaux, France

Manuscript received May 12, 2004; revised manuscript received June 24, 2004, accepted July 6, 2004.

* Reprint requests and correspondence: Dr. Gerald D. Buckberg, Department of Surgery, UCLA Medical Center, 10833 Le Conte Avenue, Room 62-258 CHS, Los Angeles, California 90095-1741 (Email: gbuckberg{at}mednet.ucla.edu).

OBJECTIVES: The purpose of this study was to test how surgical ventricular restoration (SVR) affects early and late survival in a registry of 1,198 post-anterior infarction congestive heart failure (CHF) patients treated by the international Reconstructive Endoventricular Surgery returning Torsion Original Radius Elliptical shape to the left ventricle (RESTORE)team.

BACKGROUND: Congestive heart failure may be caused by late left ventricular (LV) dilation after anterior infarction. The infarcted segment is often akinetic rather than dyskinetic because early reperfusion prevents transmural necrosis. Previously, only dyskinetic areas were treated by operation. Surgical ventricular restoration reduces LV volume and creates a more elliptical chamber by excluding scar in either akinetic or dyskinetic segments.

METHODS: The RESTORE group applied SVR to 1,198 post-infarction patients between 1998 and 2003. Early and late outcomes were examined, and risk factors were identified.

RESULTS: Concomitant procedures included coronary artery bypass grafting in 95%, mitral valve repair in 22%, and mitral valve replacement in 1%. Overall 30-day mortality after SVR was 5.3% (8.7% with mitral repair vs. 4.0% without repair; p < 0.001). Perioperative mechanical support was uncommon (<9%). Global systolic function improved postoperatively. Ejection fraction (EF) increased from 29.6 ± 11.0% preoperatively to 39.5 ± 12.3% postoperatively (p < 0.001). The left ventricular end-systolic volume index (LVESVI) decreased from 80.4 ± 51.4 ml/m2 preoperatively to 56.6 ± 34.3 ml/m2 postoperatively (p < 0.001). Overall five-year survival was 68.6 ± 2.8%. Logistic regression analysis identified EF ≤30%, LVESVI ≥80 ml/m2, advanced New York Heart Association (NYHA) functional class, and age ≥75 years as risk factors for death. Five-year freedom from hospital readmission for CHF was 78%. Preoperatively, 67% of patients were NYHA functional class III or IV and postoperatively, 85% were class I or II.

CONCLUSIONS: Surgical ventricular restoration improves ventricular function and is highly effective therapy in the treatment of ischemic cardiomyopathy with excellent five-year outcome.

Abbreviations and Acronyms
  ACE = angiotensin-converting enzyme
  CABG = coronary artery bypass grafting
  CHF = congestive heart failure
  EF = ejection fraction
  LV = left ventricular
  LVAD = left ventricular assist device
  LVESVI = left ventricular end-systolic volume index
  NYHA = New York Heart Association
  SVR = surgical ventricular restoration




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