EJCTS Click here to go to Edwards website
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Randall C. Starling
Patrick M. McCarthy
Bruce W. Lytle
Jose Navia
James B. Young
Nicholas Smedira
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by O’Neill, J. O.
Right arrow Articles by Smedira, N.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by O’Neill, J. O.
Right arrow Articles by Smedira, N.
Related Collections
Right arrow Cardiac - other
Right arrow Congestive Heart Failure
Right arrow Coronary disease

Eur J Cardiothorac Surg 2006;30:753-759
© 2006 Elsevier Science NL

The impact of left ventricular reconstruction on survival in patients with ischemic cardiomyopathy

James O. O’Neilla,c, Randall C. Starlinga,c,*, Patrick M. McCarthyb,c,d, Nancy M. Albertb,c, Bruce W. Lytleb,c, Jose Naviab,c, James B. Younga,c, Nicholas Smedirab,c

a Department of Cardiovascular Medicine, Cleveland Clinic, Desk 25, 9500 Euclid Avenue, Cleveland, OH 44195, United States
b Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, United States
c George and Linda Kaufman Center for Heart Failure, Cleveland, OH, United States
d Department of Cardiac Surgery, Northwestern University, Chicago, IL, United States

Received 14 June 2006; received in revised form 17 July 2006; accepted 19 July 2006.

* Corresponding author. Tel.: +1 216 444 2268; fax: +1 216 444 7155. (Email: starlir{at}ccf.org).


   Abstract
Top
 Abstract
1. Introduction
 2. Patients and methods
 3. Results
 4. Discussion
 References
 
Objective: Left ventricular reconstruction (LVR) is performed to improve the morphologic structure and function of the heart in patients with heart failure. This procedure has been performed at the Cleveland Clinic Foundation since 1997. We assessed mortality, functional status, and predictors of outcome in these patients. Methods: Data were extracted from multiple prospectively acquired datasets on demographic, clinical, and operative details of 220 consecutive patients who underwent LVR between July 1997 and July 2003, where the indication for surgery was heart failure (of whom 66% had New York Heart Association (NYHA) functional class III or IV symptoms). Mortality, functional status, and postoperative complications were ascertained by reference to the clinical record, social security death index, and by phone contact. Mean preoperative left ventricular ejection fraction (LVEF) was 21.5 ± 7.3% and mean left ventricular end-diastolic diameter was 6.4 ± 1.0 cm. The mean age was 61.4 ± 9.0 years and 80% were male. The majority (86%) of patients underwent concomitant coronary artery bypass grafting and 49% underwent mitral valve surgery. Results: Thirty-day mortality was 1% and survival at 1, 3, and 5 years was 92%, 90%, and 80%, respectively. Of the survivors for whom data on NYHA functional class were available, 85% were in NYHA functional class I or II. Mortality was predicted by reduced preoperative ejection fraction <20% (unadjusted hazard ratio 1.53, p = 0.02), body mass index ≤ 24 kg/m2 (unadjusted hazard ratio 1.69, p = 0.01), QRS duration ≥ 130 ms (unadjusted hazard ratio 1.66, p = 0.01) and the requirement for renal replacement therapy postoperatively (unadjusted hazard ratio 3.85, p < 0.01). Mean LVEF improved to 24.7 ± 8.86% (p < 0.01) and left ventricular volumes were also significantly reduced. Conclusions: In selected patients with heart failure, LVR, in conjunction with revascularization and valve surgery, is associated with excellent survival, improved symptoms, and improved LVEF and left ventricular dimensions.

Key Words: Heart failure • Left ventricular reconstruction • Ischemic cardiomyopathy


   1. Introduction
Top
 Abstract
 1. Introduction
2. Patients and methods
 3. Results
 4. Discussion
 References
 
Left ventricular reconstruction (LVR) is a surgical procedure performed in patients with ischemic cardiomyopathy (ICM) with the aim of restoring a more physiological shape to the failing left ventricle and to decrease end-systolic and end-diastolic volumes. The anticipated result is to improve the quality and quantity of life experienced by the patient.

LVR has been performed at the Cleveland Clinic Foundation since 1997 and these patients have been followed carefully with prospectively acquired clinical data. As such they are well-characterized cohort and their outcomes may help assess the potential benefit of LVR in patients with advanced heart failure and ICM. We feel that LVR is a viable option for select patients with this condition and sought to systematically describe procedural outcomes, survival, function status, and left ventricular morphology following surgery. We also sought to identify markers of increased mortality.


   2. Patients and methods
Top
 Abstract
 1. Introduction
 2. Patients and methods
3. Results
 4. Discussion
 References
 
2.1 Study population
Consecutive patients who underwent LVR for symptomatic heart failure at the Cleveland Clinic Foundation between July 28, 1997 and July 22, 2003 were included. Detailed demographic, clinical, and procedural data were prospectively gathered and stored on customized databases which had been approved by the Institutional Review Board of the Cleveland Clinic Foundation. Patients were selected for LVR on the basis of having symptomatic heart failure and suitable anatomy for LVR (akinetic or dyskinetic discrete scar, in a single coronary territory), according to echocardiographic, nuclear or cardiac magnetic resonance imaging. Coronary arteriography and echocardiography (see below) were performed on all patients.

The clinical characteristics of the patients are shown in Table 1 . The mean age was 61.4 ± 9 years and the majority (80%) were male. Most (84%) were white. Co-morbidities included diabetes (requiring insulin and/or oral hypoglycaemic agents) in 39%, hypertension in 52%, and chronic airways disease in 22%. Seventy-three percent were past or current smokers. Prior sternotomy was common (26%) and 17% had an implantable cardiovertor defibrillator in situ preoperatively. The mean QRS width on the resting ECG was 125 ± 33 ms. The mean body mass index was 29 ± 6 kg/m2.


View this table:
[in this window]
[in a new window]
  		Table 1. Preoperative clinical characteristics (n = 220)
 
The majority of patients (66%) had advanced heart failure symptoms at the time of surgery, New York Heart Association (NYHA) functional class III or IV. Over one half (51%) had anginal chest pain. A clinical history of myocardial infarction was elicited in 89% of patients, and the median time from the index infarction and surgery was 4.8 years (range 9 days to 30 years). A small proportion (5%) underwent LVR within 1 month of myocardial infarction. The vast majority (99%) of infarctions, which were substrate for LVR, were in the left anterior descending artery territory.

2.2 Imaging data
Detailed preoperative and postoperative echocardiographic data were available on 188 (79%) patients. Some patients had multiple echocardiograms prior to surgery and postoperative studies were performed at nonstandardized intervals, for clinical purposes. For preoperative studies, the echocardiogram closest to the day of surgery was used. For postoperative studies, echocardiograms within the first year, but at least 3 months following surgery were favored. If these were unavailable, the most proximate echocardiograms in time, with the most complete echocardiographic data were included. Of the two studies performed within 1 month, the study with the higher ejection fraction was included.

Echocardiographic data are summarized in Table 2 . The mean preoperative left ventricular ejection fraction, as assessed by two-dimensional transthoracic echocardiography, was 21.5 ± 7.3% and the median ejection fraction was 20%. Left ventricles were significantly dilated at a mean 6.4 ± 1.0 cm and 5.0 ± 1.1 cm for left ventricular end-diastolic and left ventricular end-systolic dimensions, respectively, indicating that the hearts had undergone significant remodeling prior to surgery. LV mass was markedly increased at 179 ± 57 g/m2 and 156 ± 54 g/m2. Diastolic function was abnormal in all but one patient and almost one half had severe diastolic abnormalities, with pseudonormal or restrictive mitral inflow filling patterns. One-third had moderately severe or severe mitral regurgitation.


View this table:
[in this window]
[in a new window]
  		Table 2. Echocardiographic data
 
More than one half (135) of the patients had preoperative cardiac magnetic resonance imaging studies (37 patients were unsuitable because of preoperative implantable cardiovertor defibrillators). The mean left ventricular ejection fraction by MRI was 24.7 ± 8.3%, the mean left ventricular end-diastolic volume (LVEDV) was 292 ± 79 ml, and the mean left ventricular end-systolic volume (LVESV) was 226 ± 78 ml. The mean LVESI was 120 ± 46 ml/m2. Only 71 patients had postoperative MRI studies.

2.3 Surgical technique
LVR was performed with a strategy similar to that described by Dor [1,2]. The operation was usually performed using cardiopulmonary bypass. Intraoperative trans-oesophageal echocardiography was used in all patients to assess the need for concomitant valve repair and to assist coming off cardiopulmonary bypass. Standard cardiac anesthesia was utilized. The aorta was cross clamped in the usual manner and, where appropriate, cold antegrade and retrograde blood cardioplegia were used for myocardial protection.

The myocardial scar (predominantly in the territory of the left anterior descending artery) was identified with reference to preoperative imaging and by visual inspection. An incision was made in the left ventricle parallel to the interventricular septum, parallel to the course of the left anterior descending artery. Thrombus was removed, infarcted nonviable tissue was resected, and the scar was excluded, generally by the use of a double cerclage circular closure [2]. Pericardial or Dacron patches were used as required, generally for those patients with a calcified aneurysm in whom the purse string sutures may not create a neck, or in patients with a small left ventricular cavity, to avoid creating too small a cavity [3]. A sizing balloon device was not used.

Cryoablation was used in patients with a history of ventricular tachycardia. Mitral and/or tricuspid valve repair was performed where regurgitation was felt to be greater than or equal to 2+ on the preoperative trans-oesophageal echocardiogram. Since 2000, in patients with significant preoperative intraventricular conduction delay, left ventricular pacing electrodes were applied, to allow for the later use of cardiac resynchronization therapy, if required.

Concomitant CABG was performed, where targets had been demonstrated. The heart was de-aired in the usual manner and the patients were transferred to the intensive care unit.

Operative data are summarized in Table 3 . The majority, 189 (86%) of patients had concomitant CABG. A mean of 2.4 ± 1.0 grafts were anastamosed and internal mammary arteries were utilized in 112 patients (51%). Ten percent of patients (number) had cryoablation, 29 patients (13%) underwent thrombectomy of a left ventricular thrombus, and 108 patients (49%) had mitral valve surgery, which was repaired in all but 2 patients. Other valve surgery performed included tricuspid valve repair in 20 patients (9%) and aortic valve repair/replacement in 7 patients (3%). The infarcted myocardial region was described as aneurysmal in 69% of cases at surgery. Patch closure of the ventriculotomy was performed in 37 cases (17%). Mean cross-clamp duration was 62 ± 33 min and mean cardiopulmonary bypass time was 110 ± 36 min. Mean intensive care unit (ICU) stay was 3.5 ± 4.9 days, median 2 days, and range 1–40 days.


View this table:
[in this window]
[in a new window]
  		Table 3. Operative data
 
2.4 Cardiac resynchronization therapy
Six patients had cardiac resynchronization therapy following LVR. In five patients, left ventricular pacing was achieved by connecting an epicardial lead, which had been implanted at the time of LVR. In one patient, the coronary sinus was utilized.

2.5 Concomitant medications
Secondary preventative pharmacological regimens were employed as part of the holistic therapeutic approach. Accurate prescribing data were available for 144 patients who survived to discharge. Prescription of neurohormonal antagonists was high—84% in the case of ACE inhibitors and 42% in the case of beta-blockers at hospital discharge. Statin therapy was applied in 34% of patients.

2.6 Endpoints
The primary endpoint was all cause mortality. Secondary endpoints included change in NYHA functional status and changes in left ventricular ejection fraction and dimensions.

2.7 Follow-up
Follow-up was active by telephone, review of the clinical record, or by referring to the social security death index. If patients were not available on the telephone or if the clinical record had not been updated by September 1, 2003, the social security death index was searched. The social security death index has been shown to be a reliable and robust method of assessing survival [4]. All follow-up since the last date of the data pull (December 8, 2003) was treated as follow-up only to that date. The social security death index was searched between March 15, 2004 and March 22, 2004, and had data current to the end of December 2003. Follow-up was truncated in all cases at December 8, 2003, unless death was recorded. Some patients had no social security number, in which case telephone follow-up and the clinical record were used.

2.8 Statistical analyses
Data were analyzed using JMP 5 (© SAS, Cary, NC, USA) and Number Crunching Statistical System 2001 (© NCSS Kaysveille, Utah) software. Descriptive data were expressed as mean ± standard deviation or median (range), unless otherwise specified. Survival was expressed according to the method of Kaplan and Meier and univariate comparisons were performed using the log-rank test. Unadjusted Cox proportional hazards modeling was also performed to estimate the effects of recorded variables on outcomes. Tests between groups of continuous variables were compared with the Student's t-test. Unless otherwise specified, significance was accepted at p ≤ 0.05.


   3. Results
Top
 Abstract
 1. Introduction
 2. Patients and methods
 3. Results
4. Discussion
 References
 
3.1 Survival
Patient follow-up is summarized in Table 4 . Thirty-day mortality was 1% and the median follow-up for the cohort was 786 (6–2020) days. Survival, with 95% confidence intervals, is shown as a Kaplan–Meier plot in Fig. 1 . One-, three-, and five-year survivals were 92%, 90%, and 80%, respectively. Thirty patients (14%) died during the follow-up period. Six patients (3%) required subsequent cardiac transplantation at median time of 383 (range 60–1198) days postoperatively.


View this table:
[in this window]
[in a new window]
  		Table 4. Follow-up (n = 220)
 

Figure 1
View larger version (14K):
[in this window]
[in a new window]
  		Fig. 1. Kaplan–Meier survival curve for entire patient cohort showing 95% confidence intervals and numbers at risk.

 
Unadjusted proportional hazards estimates for survival are summarized in Table 5 . Mortality decreased with increasing left ventricular ejection fraction and body mass index. A body mass index less than or equal to 24 kg/m2 was associated with an unadjusted hazard ratio of 1.69 (95% confidence interval, 1.14–2.47, p = 0.01). When converted to a categorical variable, a preoperative left ventricular ejection fraction less than 20% was associated with a hazards ratio of 1.53 (95% confidence interval, 1.06–2.19, p = 0.02) for death. A preoperative QRS duration of 130 ms or more (the current threshold for cardiac resynchronization therapy) resulted in an unadjusted hazard ratio of 1.66 (95% confidence interval, 1.13–2.45).


View this table:
[in this window]
[in a new window]
  		Table 5. Unadjusted proportional hazards estimates
 
3.2 Symptomatic response
NYHA functional class was significantly improved after surgery (p < 0.01). Of 169 patients in whom NYHA class was available at follow-up (mean duration 730 ± 490 days), 85% were in functional class I or II (Table 6 ).


View this table:
[in this window]
[in a new window]
  		Table 6. Comparison of New York Heart Association functional class pre- and post-LVR
 
3.3 Complications
Postoperative complications are summarized in Table 7 . The most common complications encountered were atrial and ventricular arrhythmias, which occurred in 37% and 19% of patients, respectively. One patient required left ventricular assist device implantation and subsequently died of progressive multi-organ failure. Overall, 12% of patients required re-admission to ICU for a significant complication.


View this table:
[in this window]
[in a new window]
  		Table 7. Postoperative complications
 
3.4 Postoperative imaging data
Mean LVEF significantly improved following LVR, from a mean of 21.5 ± 7.3% to 24.7 ± 8.6%, p < 0.01 (see Table 2). Left ventricular size was significantly reduced following surgery. There was no change in either mean left ventricular septal or posterior wall thickness. Mitral regurgitation was significantly improved following LVR and mitral valve surgery. The incidence of significant mitral regurgitation (>1+) was reduced from 49% preoperatively to 26% following surgery.

For patients who had a postoperative MRI (n = 71), mean left ventricular volumes were significantly reduced and the mean left ventricular ejection fraction was significantly increased from 24.7 ± 8.3% to 31.7 ± 10% (p < 0.001). Left ventricular end-systolic volume index was significantly reduced, from a mean of 120 ± 46 ml/m2 to 77 ± 26 ml/m2 (p = 0.001).


   4. Discussion
Top
 Abstract
 1. Introduction
 2. Patients and methods
 3. Results
 4. Discussion
References
 
This study describes the characteristics and outcomes in a group of patients who underwent LVR for heart failure due to ICM at a single institution. This was an ill cohort of patients, with a mean LVEF of 22% and 66% of patients were in NYHA functional class III or IV at the time of operation. They had significant co-morbidities, with diabetes in 39%, hypertension in 52%, and chronic obstructive airways disease in 22%. Consistent with other studies, renal function was an important independent predictor of mortality.

LVR was performed as part of a comprehensive strategy to manage heart failure in these patients. Revascularization was aggressively pursued, 86% had concomitant CABG and a mean of 2.4 grafts were anastamosed, with arterial conduits used in the majority. In addition, an aggressive strategy of mitral valve restoration was pursued, with 49% of patients undergoing mitral valve surgery, predominantly repair.

However, in this high-risk cohort survival and functional status was excellent with LVR. Only two patients died within 30 days of surgery. One-year survival was 92%. At 5 years, survival was 80% and very few patients were salvaged with cardiac transplantation. In patients for whom NYHA functional status was available, 85% were in NYHA functional class I or II at follow-up.

Almost half of the patients had mitral regurgitation requiring surgical correction. Ischemic mitral regurgitation is known to carry a high mortality. In a study of 482 patients with ischemic mitral regurgitation, 30-day mortality for the overall cohort was 13%, significantly higher than the 1% 30-day mortality presented here [5]. However, there were several important differences between the two cohorts. In Gillinov's paper, 8% underwent emergency surgery, 12% had a preoperative intraaortic balloon pump, and 20% had myocardial infarction with 14 days prior to surgery. Our cohort represented patients with chronic heart failure, and we actively excluded these patients. Hence, survival was not comparable.

Predictors of reduced survival included severely depressed preoperative left ventricular ejection fraction, lower body mass index and a QRS width >130 ms on the resting ECG.

Complications occurred in almost one half of the cohort, most commonly atrial fibrillation. The mean length of ICU stay was relatively protracted, at 3.5 days, giving some indication of how ill these patients were. Despite this, only 7% required an intraaortic balloon pump and one patient required emergency left ventricular assist implantation. 12% of patients required readmission to the intensive care unit.

Our group has previously described is a significant risk of late ventricular arrhythmias in these patients [6]. Up to 16% of patients with an implantable defibrillator (implanted for either primary or secondary prevention) may develop ventricular arrhythmias requiring therapy within the first year following surgery. This has prompted us to adopt a strategy of either predischarge electrophysiological study or implantable cardiovertor defibrillator insertion. Currently we reassess the ejection fraction at least 40 days postoperatively and consider implantable cardiovertor when the ejection fraction is less than or equal to 30%. Thus, the importance of concomitant appropriate adjunctive device therapy for improving intermediate survival must be emphasized.

Left ventricular morphology and function was significantly improved after surgery, as evidenced by the increase in LVEF by both echocardiography and MRI. In addition, left ventricular systolic and diastolic volumes were reduced by one-third and one-fourth, respectively. Left ventricular dilatation following myocardial infarction is a harbinger of the development of heart failure and left ventricular end-systolic volume index is a strong predictor or mortality. Patients with LVEF <30% and left ventricular end-systolic volume index >100 ml/m2 have a 5-year survival of 54% [7]. Furthermore, increased preoperative left ventricular size predicts a poor outcome following CABG patients with preoperative ejection fractions <30% and a left ventricular end-systolic volume index >100 ml/m2 have a 5-year survival of only 54% [8]. This study suggests that by reducing left ventricular volume by LVR, survival may be improved however we await the results of the STICH trial which has randomized patients similar to those reported in this experience to coronary artery bypass alone versus concomitant LVR.

According to observational and randomized studies, CABG improves survival in patients with impaired left ventricular function (<50%) and multi-vessel obstructive CHD [9,10]. Initial randomized controlled trials comparing CABG to medical treatment between 1972 and 1978 excluded patients with severe LV dysfunction. In a subgroup of 160 Coronary Artery Surgery Study patients with left ventricular ejection fraction <50%, the 10-year survival was 61% in the 82 medially treated patients and 79% in the 78 patients who had CABG [11]. The survival benefit of CABG was not related to the presence or severity of heart failure or angina symptoms [12].

The paucity of data regarding patients with severe ICM undergoing CABG was demonstrated in a meta-analysis of seven randomized trials of CABG [13]. Only 191 (7.2%) of the 2649 patients had an ejection fraction less than 40% and only 106 (4%) of these had heart failure symptoms. CABG improved survival among all patients (including those with heart failure) with proximal left anterior descending coronary artery disease, 3 vessel or left main coronary disease. In three well-designed cohort studies of CABG in advanced ICM, the mortality benefit of CABG over medical therapy was 10–20 lives per 100 patients at 3 years in two studies and 29 lives per 100 patients at 5 years in the third study [14]. Another, more contemporary study reported that the 5- and 8-year survivals among patients undergoing CABG with an ejection fraction <30% is 65% and 35%, respectively [15].

Improved blood supply can reanimate areas of hibernation and reduce ischemic territories, which may prevent further tissue necrosis. By improving myocardial contractility, adverse remodeling may be reduced in other areas of the myocardium. Revascularization on its own can improve left ventricular ejection fraction and reduce left ventricular size [16]. However, there is increasing concern that revascularization alone only treats part of the problem of ischemic cardiomyopathy, and the surgeon should holistically approach ‘the vessels, the valves and the ventricle’ [17].

In theory, LVR will reverse and retard adverse remodeling and improve cardiac structure, hence facilitating improved long-term outcomes.

Dor's series described an 8-year survival of 69%, in patients undergoing LVR [18]. The largest comparable series previously published is the RESTORE group [19,20]. Comparing the population here to other reported series, the mean age is similar between the two groups, but here the similarities end. Left ventricular function is worse and left ventricular volumes larger in our cohort. Concomitant CABG was performed less frequently in our cohort, while mitral valve surgery was performed more often in our group. The requirement for intraaortic balloon pump postoperatively was similar. In addition, survival and morbidity were similar between the three groups.

In another series recently published by Sartipy et al. [21], 101 patients who underwent LVR had a 1-, 3- and 5-year survival of 88%, 79%, and 65%, respectively. All patients had class II–IV heart failure symptoms. The mean age was similar, though the mean left ventricular ejection fraction, at 27%, was somewhat better than that in our cohort. Five-year survival was similar.

4.1 Limitations
The degree to which the excellent survival here was due to LVR, rather than to CABG, aggressive medication use or adjunctive device therapy, is difficult to estimate. This was an observational study, with no control group. However, our group has previously reported on nontransplant surgical treatments for heart failure and shown them to be associated with better outcomes than being placed on the waiting list for cardiac transplantation [22].

The relative merit of LVR, with and without CABG is currently under evaluation in a multi-center randomized controlled trial (Surgical Treatment of Ischaemic Cardiomyopathy, www.stich.org) [12]. Our series presented here, although not a randomized controlled trial, did include all patients undergoing the procedure at a single center and provides important insights.

In summary, LVR in selected patients carries a low perioperative mortality and excellent 5-year survival. A significant improvement in heart failure symptoms was observed and LVR should be considered as part of a comprehensive surgical approach in carefully identified patients with heart failure and a discrete left ventricular scar.


   Acknowledgments
 
The authors would like to acknowledge the editorial assistance of Eugene H. Blackstone, MD, in the preparation of this manuscript. Dr O’Neill receives support from the Fulbright Commission.


   References
Top
 Abstract
 1. Introduction
 2. Patients and methods
 3. Results
 4. Discussion
 References
 

  1. Dor V. Left ventricular aneurysms: the endoventricular circular patch plasty. Semin Thorac Cardiovasc Surg 1997;9(2):123-130.[Medline]
  2. Caldeira C, McCarthy PM. A simple method of left ventricular reconstruction without patch for ischemic cardiomyopathy. Ann Thorac Surg 2001;72(6):2148-2149.[Abstract/Free Full Text]
  3. Lee R, Hoercher KJ, McCarthy PM. Ventricular reconstruction surgery for congestive heart failure. Cardiology 2004;101(1–3):61-71.[CrossRef][Medline]
  4. Curb JD, Ford CE, Pressel S, Palmer M, Babcock C, Hawkins CM. Ascertainment of vital status through the National Death Index and the Social Security Administration. Am J Epidemiol 1985;121(5):754-766.[Abstract/Free Full Text]
  5. Gillinov AM, Wierup PN, Blackstone EH, Bishay ES, Cosgrove DM, White J, Lytle BW, McCarthy PM. Is repair preferable to replacement for ischemic mitral regurgitation?. J Thorac Cardiovasc Surg 2001;122(6):1125-1141.[Abstract/Free Full Text]
  6. O’Neill JO, Starling RC, Khaykin Y, McCarthy PM, Young JB, Hail M, Albert NM, Smedira N, Chung MK. Residual high incidence of ventricular arrhythmias after left ventricular reconstructive surgery. J Thorac Cardiovasc Surg 2005;130(5):1250-1256.[Abstract/Free Full Text]
  7. Yamaguchi H, Hasegawa S, Yoshioka J, Uehara T, Hashimoto K, Kusuoka H, Kuzuya T, Hori M, Nishimura T. Characteristics of myocardial 18F-fluorodeoxyglucose positron emission computed tomography in dilated cardiomyopathy and ischemic cardiomyopathy. Ann Nucl Med 2000;14(1):33-38.[Medline]
  8. Yamaguchi A, Ino T, Adachi H, Murata S, Kamio H, Okada M, Tsuboi J. Left ventricular volume predicts postoperative course in patients with ischemic cardiomyopathy. Ann Thorac Surg 1998;65(2):434-438.[Abstract/Free Full Text]
  9. Myers WO, Blackstone EH, Davis K, Foster ED, Kaiser GC. CASS Registry long term surgical survival. Coronary Artery Surgery Study. J Am Coll Cardiol 1999;33(2):488-498.[Abstract/Free Full Text]
  10. Killip T, Passamani E, Davis K. Coronary artery surgery study (CASS): a randomized trial of coronary bypass surgery. Eight years follow-up and survival in patients with reduced ejection fraction. Circulation 1985;72(6 Pt 2):V102-V109.[Medline]
  11. Alderman EL, Bourassa MG, Cohen LS, Davis KB, Kaiser GG, Killip T, Mock MB, Pettinger M, Robertson TL. Ten-year follow-up of survival and myocardial infarction in the randomized Coronary Artery Surgery Study. Circulation 1990;82(5):1629-1646.[Abstract/Free Full Text]
  12. Jones RH. Is it time for a randomized trial of surgical treatment of ischemic heart failure?. J Am Coll Cardiol 2001;37(5):1210-1213.[Free Full Text]
  13. Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW, Davis K, Killip T, Passamani E, Norris R, Morris C, Mathur V, Varnauskas ED, Chalmers TC. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery. Trialists Collaboration. Lancet 1994;344(8922):563-570.[CrossRef][Medline]
  14. Baker DW, Jones R, Hodges J, Massie BM, Konstam MA, Rose EA. Management of heart failure. III. The role of revascularization in the treatment of patients with moderate or severe left ventricular systolic dysfunction. J Am Med Assoc 1994;272(19):1528-1534.[Abstract/Free Full Text]
  15. Trachiotis GD, Weintraub WS, Johnston TS, Jones EL, Guyton RA, Craver JM. Coronary artery bypass grafting in patients with advanced left ventricular dysfunction. Ann Thorac Surg 1998;66(5):1632-1639.[Abstract/Free Full Text]
  16. Elefteriades J, Edwards R. Coronary bypass in left heart failure. Semin Thorac Cardiovasc Surg 2002;14(2):125-132.[CrossRef][Medline]
  17. O’Neill JO, Starling RC. Surgical remodeling in ischemic cardiomyopathy. Curr Treat Options Cardiovasc Med 2003;5(4):311-319.
  18. Dor V, Sabatier M, Di Donato M, Montiglio F, Toso A, Maioli M. Efficacy of endoventricular patch plasty in large postinfarction akinetic scar and severe left ventricular dysfunction: comparison with a series of large dyskinetic scars. J Thorac Cardiovasc Surg 1998;116(1):50-59.[Abstract/Free Full Text]
  19. Athanasuleas CL, Stanley AW, Buckberg GD, Dor V, Di Donato M, Siler W. Surgical anterior ventricular endocardial restoration (SAVER) for dilated ischemic cardiomyopathy. Semin Thorac Cardiovasc Surg 2001;13(4):448-458.[Medline]
  20. Athanasuleas CL, Stanley Jr. AW, Buckberg GD, Dor V, DiDonato M, Blackstone EH. Surgical anterior ventricular endocardial restoration (SAVER) in the dilated remodeled ventricle after anterior myocardial infarction. RESTORE group. Reconstructive endoventricular surgery, returning torsion original radius elliptical shape to the LV. J Am Coll Cardiol 2001;37(5):1199-1209.[Abstract/Free Full Text]
  21. Sartipy U, Albage A, Lindblom D. The Dor procedure for left ventricular reconstruction. Ten-year clinical experience. Eur J Cardiothorac Surg 2005;27(6):1005-1010.[Abstract/Free Full Text]
  22. Mahon NG, O’Neill JO, Young JB, Bennett R, Hoercher K, Banbury MK, Navia JL, Smedira NG, McCarthy PM, Starling RC. Contemporary outcomes of outpatients referred for cardiac transplantation evaluation to a tertiary heart failure center: impact of surgical alternatives. J Card Fail 2004;10(4):273-278.[CrossRef][Medline]



This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
G. D. Buckberg and C. L. Athanasuleas
The STICH trial: Misguided conclusions.
J. Thorac. Cardiovasc. Surg., November 1, 2009; 138(5): 1060 - 1064.e2.
[Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
H. Suma, H. Tanabe, T. Uejima, T. Isomura, and T. Horii
Surgical ventricular restoration combined with mitral valve procedure for endstage ischemic cardiomyopathy
Eur. J. Cardiothorac. Surg., August 1, 2009; 36(2): 280 - 285.
[Abstract] [Full Text] [PDF]

Home page
 Circ Heart FailHome page
E. C. McGee Jr
Surgery, Mitral Regurgitation, and Heart Failure: The Valves Are All Repairable But the Patients Are Not
Circ Heart Fail, November 1, 2008; 1(4): 285 - 289.
[Full Text] [PDF]

Home page
 RadiologyHome page
Z.-Z. Song, R. M. Setser, B. B. Carmichael, and R. D. White
Surgical Ventricular Restoration and Left Ventricular Function
Radiology, February 1, 2008; 246(2): 652 - 653.
[Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
R. M. Setser, N. G. Smedira, M. L. Lieber, E. D. Sabo, and R. D. White
Left ventricular torsional mechanics after left ventricular reconstruction surgery for ischemic cardiomyopathy.
J. Thorac. Cardiovasc. Surg., October 1, 2007; 134(4): 888 - 896.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
R. H. Jones
The Year in Cardiovascular Surgery
J. Am. Coll. Cardiol., May 8, 2007; 49(18): 1887 - 1898.
[Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Randall C. Starling
Patrick M. McCarthy
Bruce W. Lytle
Jose Navia
James B. Young
Nicholas Smedira
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by O’Neill, J. O.
Right arrow Articles by Smedira, N.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by O’Neill, J. O.
Right arrow Articles by Smedira, N.
Related Collections
Right arrow Cardiac - other
Right arrow Congestive Heart Failure
Right arrow Coronary disease

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS