Surgical anterior ventricular endocardial restoration (SAVER) in the dilated remodeled ventricle after anterior myocardial infarction
Constantine L. Athanasuleas, MD*,
Alfred W. H. Stanley, Jr., MD*,
Gerald D. Buckberg, MD ,
Vincent Dor, MD ,
Marissa DiDonato, MD ,
Eugene H. Blackstone, MD|| the RESTORE group
* 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
View larger version (75K):
[in a new window]
|
Figure 1 The anterior ventricular scar (akinesia or dyskinesia) is opened and inspected. Palpation of the open-beating heart precisely delineates the margins of contracting tissue. Reproduced with permission © 1999 Floyd E. Hosmer.
|
|
View larger version (53K):
[in a new window]
|
Figure 2 An encircling suture separates the viable myocardium from scar and when tightened forms an oval platform onto which a patch can be secured, usually 2 by 3 cm. Reproduced with permission © 1999 Floyd E. Hosmer.
|
|
View larger version (49K):
[in a new window]
|
Figure 3 The dacron patch is sewn into place either by mattressed interrupted sutures brought from outside of the ventricle to its interior or by an internal continuous running stitch. Reproduced with permission © 1999 Floyd E. Hosmer.
|
|
View larger version (50K):
[in a new window]
|
Figure 4 The remaining akinetic or dyskinetic noncontracting scar is sewn over the patch and aids in hemostasis. Reproduced with permission © 1999 Floyd E. Hosmer.
|
|
View larger version (16K):
[in a new window]
|
Figure 5 Prevalence of performing a concomitant mitral valve procedure according to preoperative ejection fraction. Closed circles represent the observed proportion of patients receiving a mitral valve procedure in roughly 10% increments in ejection fraction. The number of patients in each group is shown for each dot. The solid line and its confidence limits are a trend line from logistic regression (p < 0.0001).
|
|
View larger version (20K):
[in a new window]
|
Figure 6 Prevalence of the need for post-SAVER mechanical support according to the level of postoperative ejection fraction and whether a mitral valve procedure (repair or replacement) was performed. The depiction is a nomogram from the multivariable logistic regression analysis.
|
|
View larger version (13K):
[in a new window]
|
Figure 7 Overall survival after the SAVER operation. Circles represent a death and are positioned on the horizontal axis at the time of the death and on the vertical axis according to the Kaplan-Meier estimator. The vertical bars are asymmetric confidence limits equivalent to one standard error. The solid line enclosed by dashed line confidence limits is the parametric survival estimate. The numbers at the foot of the graph represent the number of patients still traced at three-month intervals.
|
|
View larger version (20K):
[in a new window]
|
Figure 8 Survival after the SAVER operation according to whether the mitral valve was replaced. In general, the format is as in Figure 3, with circles representing patients who did not have mitral valve replacement (but may have had mitral valve repair) and squares representing patients with mitral valve replacement. The numbers in parentheses along each curve represent the number of patients still traced beyond that point in time.
|
|
View larger version (13K):
[in a new window]
|
Figure 9 Nomogram of 18-month survival after the SAVER operation from the multivariable analysis of death. To construct this risk-adjusted depiction, age at operation was set at 60 years, and mitral valve replacement was set to "no." Note the expanded vertical axis. The solid line is the estimate, and the dashed lines are the asymmetric confidence limits.
|
|
View larger version (21K):
[in a new window]
|
Figure 10 Nomogram of 18-month survival after the SAVER operation according to age and levels of ejection fraction from the multivariable analysis of death. For this depiction, mitral valve replacement was set to "no."
|
|
View larger version (16K):
[in a new window]
|
Figure 11 Freedom from rehospitalization for chronic heart failure (CHF) after the SAVER operation. The format of the figure is as for Figures 3 and 4, except that the hazard function (instantaneous risk of rehospitalization for CHF) has been superimposed. It is scaled as % risk of rehospitalization per year.
|
|
View larger version (14K):
[in a new window]
|
Figure 12 Nomogram of 18-month freedom from rehospitalization for chronic heart failure (CHF) according to postoperative ejection fraction. For this risk-adjusted depiction, age was set at 60 years. The solid line is the point estimate, and the dashed lines are their confidence limits.
|
|
|
