Insights from the STICH trial: change in left ventricular size after coronary artery bypass grafting with and without surgical ventricular reconstruction.

Objective: The present analysis of the Surgical Treatment for Ischemic Heart Failure randomized trial data examined the left ventricular volumes at baseline and 4 months after surgery to determine whether any magnitude of postoperative reduction in end-systolic volume affected survival after coronary artery bypass grafting alone compared with bypass grafting plus surgical ventricular reconstruction.

Methods: Of the 1000 patients randomized, 555 underwent an operation and had a paired imaging assessment with the same modality at baseline and 4 months postoperatively. Of the remaining 455 patients, 424 either died before the 4-month study or did not have paired imaging tests and were excluded, and 21 were not considered because they had died before surgery or did not receive surgery.

MicroRNA dysregulation in diabetic ischemic heart failure patients.

Increased morbidity and mortality associated with ischemic heart failure (HF) in type 2 diabetic patients requires a deeper understanding of the underpinning pathogenetic mechanisms. Given the implication of microRNAs (miRNAs) in HF, we investigated their regulation and potential role. miRNA expression profiles were measured in left ventricle biopsies from 10 diabetic HF (D-HF) and 19 nondiabetic HF (ND-HF) patients affected by non-end stage dilated ischemic cardiomyopathy.

Baseline left ventricular volume and shape as determinants of reverse remodeling induced by surgical ventricular reconstruction.

Background: Early postoperative data show that surgical ventricular reconstruction (SVR) induces reverse remodelling (RR) in dilated ischemic cardiomyopathy. The stability of these results at follow-up is debated. This retrospective study determined whether RR was stable at follow-up and the role, if any, of preoperative left ventricle volume and shape on SVR-induced changes.

Surgical ventricular restoration to reverse left ventricular remodeling.

Heart failure is one of the major health care issues in the Western world. An increasing number of patients are affected, leading to a high rate of hospitalization and high costs. Even with administration of the best available medical treatment, mortality remains high.

Optimizing dose and administration regimen of a high-relaxivity contrast agent for myocardial MRI late gadolinium enhancement.

Objectives: To investigate the time-course of late gadolinium enhancement of infarcted myocardium using gadobenate dimeglumine at different dosages and administration regimens.

Materials And Methods: After institutional review board approval and informed consent, we studied 13 patients (aged 63±11 years) with chronic myocardial infarction. They underwent two gadobenate dimeglumine-enhanced MR examinations (interval 24-48 h) using short-axis inversion-recovery gradient-echo sequences, with the following two different protocols, in randomized order: 0.

Impact of surgical ventricular reconstruction on stroke volume in patients with ischemic cardiomyopathy.

Objective: Left ventricular end-diastolic volume is decreased and ejection fraction is increased after surgical ventricular reconstruction; however, the impact on left ventricular stroke volume is not well established.

Methods: We analyzed 248 consecutive patients who underwent surgical ventricular reconstruction at a single center. There were 14 perioperative deaths (5.

End-systolic volume following surgical ventricular reconstruction impacts survival in patients with ischaemic dilated cardiomyopathy.

Aims: A left ventricular end-systolic volume (LVESV) > or =60 mL/m(2) has been shown to be associated with increased cardiac mortality after a reperfused myocardial infarction (MI). The reduction in LVESV following surgical ventricular reconstruction (SVR) is reported to be between 19% and 50% but its impact on prognosis is not well-established. The aim of this study was therefore to assess the impact on survival of a residual LVESV index (LVESVI) of > or = or <60 mL/m(2) following SVR.

N-terminal pro-brain natriuretic peptide and outcomes in patients undergoing surgical ventricular restoration.

N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels have been shown to be increased at baseline in patients undergoing surgical ventricular restoration (SVR) of the left ventricle. However, changes in the values of this marker in the early postoperative period and its prognostic significance remain less known in these patients. We evaluated 31 consecutive patients undergoing SVR who had NT-pro-BNP determined a day before SVR and from postoperative days 0 to 4.

Surgical ventricular reconstruction with different myocardial protection strategies. A propensity matched analysis.

The aim of this study is to compare outcomes of patients undergoing surgical ventricular reconstruction (SVR) with normothermic cardiopulmonary bypass (CPB) and beating heart or hypothermic CPB and cardioplegic arrest. Between 2001 and 2008, 588 patients underwent SVR. A propensity score matching was performed and 91 matched pairs were created: group 1 (G1) operated with normothermic CPB and beating-heart technique, and group 2 (G2) operated with hypothermic CPB and cardioplegic arrest.

Effects of surgical ventricular reconstruction on diastolic function at midterm follow-up.

Objective: Limited data are available on the effects of surgical ventricular reconstruction on diastolic function. The aim of the present study was to evaluate changes in diastolic function induced by surgical ventricular reconstruction at 2 time intervals after surgery (discharge and follow-up) and to assess the impact of diastolic changes on clinical outcome.

Methods: A total of 129 patients (65 +/- 9 years, 14 women) underwent echocardiographic Doppler evaluation before surgical ventricular reconstruction, at discharge, and at follow-up (median 7 months).

Diabetes mellitus and long-term outcome in heart failure patients after surgical ventricular restoration.

Background: This study aimed to identify the impact of diabetes mellitus and related comorbidities on long-term survival of heart failure patients who had undergone surgical ventricular restoration. Surgical ventricular restoration is an optional therapeutic strategy for patients with ischemic dilated cardiomyopathy. Reported prognostic predictors for late morbidity and mortality are predominantly related to cardiac conditions, whereas the prognostic impact of comorbidities still needs to be defined.

Surgical treatment of ischemic heart failure: the Dor procedure.

Despite the improvements in the treatment of myocardial infarction that have translated into a decline in mortality rates, the incidence of heart failure has increased and, because of the limited number of cardiac donors, non-transplant heart surgery has developed in the past 10 years. Surgical ventricular reconstruction was launched by Dor and defined as endoventricular circular patch plasty repair. It represents a relatively novel surgical approach aiming to restore (bring back to normal) the dilated, distorted left ventricular (LV) cavity in order to improve function.

Surgical ventricular restoration: left ventricular shape influence on cardiac function, clinical status, and survival.

Background: Myocardial infarction can result in a spectrum of left ventricular (LV) shape abnormalities. Surgical ventricular restoration (SVR) can be applied to any, but there are no data that relate its effectiveness to LV shape. Moreover, there is no consensus on the benefit of SVR in patients with a markedly dilated ventricle, without clear demarcation between scarred and normal tissue.

Impact of surgical ventricular restoration on diastolic function: implications of shape and residual ventricular size.

Background: Limited data are available on left ventricle (LV) diastolic function in patients with ischemic dilated cardiomyopathy submitted to surgical ventricular restoration (SVR). The purpose of this study was to assess postoperative diastolic function changes and identify potential predictors of its worsening.

Methods: One hundred and forty-six patients (65 +/- 9 years) with previous anterior myocardial infarction were evaluated before and after SVR.

The Ross procedure in adults: long-term follow-up and echocardiographic changes leading to pulmonary autograft reoperation.

Background: This is a clinical investigation of the mid- to long-term follow-up of the Ross procedure in adult patients. The primary end point is to explore the incidence and risk factors for a reoperation on the pulmonary autograft. The secondary end points are to explore the incidence of neoaortic root dilation and valve regurgitation, and the echocardiographic profile leading to a reoperation.

Aortic valve replacement in octogenarians: is biologic valve the unique solution?

Background: This study analyzed morbidity, mortality, and quality of life after aortic valve replacement with mechanical and biologic prostheses in octogenarian patients.

Methods: A retrospective analysis was performed in 345 consecutive patients, mean age of 82 +/- 2 years (range, 80 to 92), who had aortic valve replacement from May 1991 to April 2005. A bioprosthesis (group I) was used in 200 patients (58%), and 145 (42%) received a mechanical prosthesis (group II).

Effectiveness of surgical ventricular restoration in patients with dilated ischemic cardiomyopathy and unrepaired mild mitral regurgitation.

Objective: Any grade of ischemic mitral regurgitation is associated with excess mortality. Whether mild ischemic mitral regurgitation should be repaired at the time of either coronary artery bypass grafting or surgical ventricular restoration is controversial. Surgical ventricular restoration is a treatment option for dilated post-infarction cardiomyopathy and has the potential to improve mitral functioning.

Surgical therapy for ischemic heart failure: single-center experience with surgical anterior ventricular restoration.

Objectives: Our objectives were (1) to report operative and long-term mortality in patients submitted to anterior surgical ventricular restoration, (2) to report changes in clinical and cardiac status induced by surgical ventricular restoration, and (3) to report predictors of death in a large cohort of patients operated on at San Donato Hospital, Milan, Italy.

Methods: A total of 1161 consecutive patients (83% men, 62 +/- 10 years) had anterior surgical ventricular restoration with or without coronary artery bypass grafting and with or without mitral repair/replacement. A complete echocardiographic study was performed in 488 of 1161 patients operated on between January 1998 and October 2005 (study group).

Left ventricular restoration: how important is the surgical treatment of ischemic heart failure trial?

If the Surgical Treatment of Ischemic Heart Failure (STICH) trial demonstrates that surgical therapy is superior to medical therapy, early aggressive evaluation of coronary artery disease as a potentially correctable cause of new-onset heart failure would be the preferred strategy. This strategy could tremendously change the treatment of ischemic heart disease. Confirming the STICH revascularization hypothesis will dramatically increase the use of coronary artery bypass grafting among the millions of patients now being medically treated without evaluation for an ischemic cause.

Preoperative and late postoperative mitral regurgitation in ventricular reconstruction: role of local left ventricular deformation.

Background: We sought to analyze the characteristics of local left ventricular deformation related to functional mitral regurgitation (MR) in post-anterior myocardial infarction scar, and to evaluate how local remodeling contributes to late development of MR after surgical ventricular reconstruction by endoventricular circular patch plasty repair.

Methods: Two hundred twenty-one consecutive patients (aged 60 +/- 9 years; 193 males) with previous transmural anterior infarction underwent heart catheterization both before and 1 year after endoventricular circular patch plasty repair. Preoperative global left ventricular shape determinants (eccentricity and circularity indexes), regional curvature and wall motion (centerline), and both preoperative and 1-year postoperative hemodynamic parameters (volumes, ejection fraction, capillary wedge and pulmonary artery pressures) were calculated.

Right ventricular restoration during pulmonary valve implantation in adults with congenital heart disease.

Objective: Pulmonary regurgitation may cause progressive right ventricular dilatation and dysfunction in adult patients previously repaired for right ventricular outflow tract obstruction (RVOTO), and who require subsequent valve implantation for relief of these symptoms. Right ventricular recovery after pulmonary valve implantation (PVI) may be closely linked to the functional importance of the structural presence of an aneurysm or akinetic segment in the RVOT area. To test this concept, the impact of the right ventricular restoration with a new surgical ventriculoplasty technique is evaluated following pulmonary valve implantation in patients with severe pulmonary regurgitation and right ventricular dilatation.

Left ventricular geometry in normal and post-anterior myocardial infarction patients: sphericity index and 'new' conicity index comparisons.

Background: Anterior myocardial infarction leads a sequence of structural changes that alter the size and the shape of the left ventricle. Efforts to assess shape have been made by global left ventricular (LV) chamber analysis (sphericity index, SI) but this analysis does not detect regional shape abnormalities like those at the apical level, which precede global ventricular dilatation.

Objective: The present study will introduce a new analysis of regional apical changes in 52 normal subjects and in 92 patients with previous anterior myocardial infarction.