SURGICAL OPTIONS FOR THE TREATMENT OF HEART FAILURE Developments in Cardiovascular Medicine VOLUME 225 The titles published in this series are listed at the end of this volume. Surgical Options for the Treatment of Heart Failure edited by ROY G. MASTERS, MD FRCSC Division of Cardiac Surgery; University of Ottawa Heart Institute, Ottawa, Ontario, Canada KLUWER ACADEMIC PUBLISHERS DORDRECHT / BOSTON I LONDON A C.I.P. Catalogue record for this book is available from the Library of Congress ISBN 0-7923-61 30-X Published by Kluwer Academic Publishers, P.O. Box 17,3300 AA Dordrecht, The Netherlands. Sold and distributed in North, Central and South America by Kluwer Academic Publishers, 101 Philip Drive, Norwell, MA 02061, U.S.A. In all other countries, sold and distributed by Kluwer Academic Publishers, P.O. Box 322,3300 AH Dordrecht, The Netherlands. Printed on acid-free paper All Rights Reserved 0 1999 Kluwer Academic Publishers No part of the material protected by this copyright notice may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission from the copyright owner. Printed in the Netherlands. Table of Contents List of Contributors Introduction by Wilbert J. Keon vii xi 1. Pathophysiology of Contractile Dysfunction in Heart Failure Naranjan S. Dlida, Jingwei Wang, and Xiaobing Guo 1 2. Coronary Artery Bypass for Advanced Left Ventricular Dysfunction John Elefleriades, Geroge Tellides, Habib Samady, Meher Yepremyan, Umer Darr, Fraw J Th. Wackers, and Barry Zaret 15 3. Valve Surgery for Regurgitant Lesions of the Aortic or Mitral Valves in Advanced Left Ventricular Dysfunction Robert 0. Bonow and Roy G. Masters 3 3 4. Left Ventricular Aneurysm Repair for the Management of Left Ventricular Dyshction Wilbert J. Keon and Lloyd C. Semelhago 49 5. Selection and Management of the Potential Candidate for Cardiac Transplanatation Lynne Warner Stevenson 6 1 6. The Registry of the International Society for Heart and Lung Transplantation: Fifteenth Oficial Report - 1998 Jeffrey D. Hosenpud, Leah E. Bennett, Berkeley M. Keck, Bennie Fiol, MarkM Boucek, Richard J. Novick 7. Mechanical Circulatory Support Joe Helou and Robert L.Kormos 8. Dynamic Cardiomyoplasty Vinay Badhwar, David Francischelli, and Ray C.J. Chiu 9. Partial Left Ventriculectomy RichardJ. KapIon andPatrickM McCarthy 10. Xenotransplantation Furah N.K. Bhatti np2d John Wallwork 11. Permanent Mechanical Circulatory Support TofiMussivund, PmlJ Hewdiy, Roy G Masters, and Wilbert J Keon List of Contributors Vinay Badhwar McGill Uniiversity, Division of Cardiovascular and Thoracic Surgery, Montreal General Hospital, Montreal, Canada Leah E. Bennett ISHLT Registry, Richmond, VA, U.S.A. Farah N.K. Bhatti Papworth Hospital, Papworth, Everard, Cambridge, United Kingdom Robert O. Bonow Northwestern University Medical School, Division of Cardiology, Chicago, IL, U.S.A. Mark M. Boucek ISHLT Registry, Richmond, VA, U.S.A. Ray C-J Chiu McGill Uniiversity, Division of Cardiovascular and Thoracic Surgery, Montreal General Hospital, Montreal, Canada Umer Darr Yale University, Cardiothoracic Surgery, New Haven, Connecticut, U.S.A. Naranjan S. Dhalla University of Manitoba, Institute of Cardiovascular Sciences, St.Boniface General Hospital Research Center, Winnipeg, Canada Joh. A. Elefteriades Yale University, Cardiothoracic Surgery, New Haven, Connecticut, U.S.A. Bennie Fiol ISHLT Registry, Richmond, VA, U.S.A. David Francsichelli Medtronic Inc., Minneapolis, Minnesota, U.S.A. Xiaobing Guo University of Manitoba, Institute of Cardiovascular Sciences, St.Boniface General Hospital Research Center, Winnipeg, Canada Joe Helou University of Ottawa, Ottawa Heart Institute, Ottawa, Canada VIII Paul J. Hendry University of Ottawa, Ottawa Heart Institute, Ottawa, Canada Jeiirey D. Hosenpud ISHLT Registry, Richmond, VA, U.S.A. Richard J. Kaplon Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A. Berkeley M. Keck ISHLT Registry, Richmond, VA, U.S.A. Wilbert J. Keon University of Ottawa, Ottawa Heart Institute, Ottawa, Canada Robert Kormos University of Pittsburgh, Pittsburgh, Pennsylvania U.S.A. Roy G. Masters University of Ottawa, Ottawa Heart Institute, Ottawa, Canada Patrick M. McCarthy Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A. Toiy Mussivand University of Ottawa, Ottawa Heart Institute, Ottawa, Canada Richard Novick ISHLT Registry, Richmond, VA, U.S.A. Habib Samady Yale University, Cardiothoracic Surgery, New Haven, Connecticut, USA. Lloyd C. Semelhago McMaster University, McMaster Clinical Unit, Hamilton, Canada Lynne Warner Stevenson Harvard Medical School, Brigham and Women's Hospital, Boston, MA. U.S.A. George Tellides Yale University, Cardiothoracic Surgery, New Haven, Connecticut, USA IX John Wallwork Papworth Hospital, Papworth, Everard, Cambridge, UK Jingwei Wang University of Manitoba, Institute of Cardiovascular Sciences, St.Boniface General Hospital Research Center, Winnipeg, Canada Franz J. Th. Whackers Yale University', Cardiothoracic Surgery, New Haven, Connecticut, U.S.A. Mehcr Yepremyan Yale University, Cardiothoracic Surgery, New Haven, Connecticut, U.S.A. Bany Zaret Yale University, Cardiothoracic Surgery, New Haven, Connecticut, U.S.A. Introduction Despite the significant decline in heart disease mortaht>' rates over the last 25 years, heart failure has remained a significant problem. We are now confronted with large numbers of terminally ill patients for whom conventional therapies for heart failure have been exhausted and for whom repeated hospital visits are necessary. There now is a major thrust towards a management strategy which embraces a comprehensive approach including vigorous preventive measures and earlier surgical interventions. This book outlines the major surgical options for the treatment of heart failure and brings together a very broad base of opinions with contributions from several outstanding individuals. With the improved knowledge and techniques to control rejection, transplantation has become the central pillar in the surgical management of this group of patients. Unfortunately, because of limited donor supply the teclmique cannot be applied to large numbers of patients. A great deal of excitement, however, exists in the potential for xenotransplantation as a supplement to homotransplantation. The use of cardiac assist devices has become a reality with several hundred LVADS and BiVADS implanted throughout the world and cardiac replacement with total artificial hearts continues to be used successfully as a bridge to transplantation. We are on the thieshold of the broad application of assist devices to provide prolonged relief of heart failure and restore patients to an ambulatoiy home environment and hopefully return to the work force in significant numbers. The renewed interest in ventricular remodelling, early mitral valve repair, improved techniques for dealing with ventricular aneurysms and early revascularization during acute ischemic episodes has opened the doors to significant improvements in cardiac function in large numbers of heart failure patients. This represents yet another opportunity to prolong the lives and relieve the suffering of heart failure patients and leave the door open for ultimate cardiac replacement with either transplantation or devices should this be necessary This book is a timely and useful contribution to the overall knowledge of the management of the heart failure patient and provides a useful and worthwhile read for every cardiac surgeon of the day. Wilbert J. Keon University of Ottawa Heart Institute Ottawa, Canada [...]... infarct border zones, whether or not we can demonstrate them by viability imaging EF Change (Pre- to Post-Operative) EF Change (Pre to Post-Operative) 30 25 20 H 15 m 10 5- -1 5 .0 -1 0.0 -5 .0 0.0 5.0 10 .0 15 .0 20.0 25.0 30.0 35.0 40.0 45.0 EF Change (%) Kigure -4 Histogram ofEFchanjie The number ofpatients is on they-axis and the magnitude of HI' changed on the X-axis The line for zero EF change is indicated... low EF from the present decade #of Author (Dale) palicnls EF(%) (range) EF(%) (mean) Hospital Mortality PostOp Mean Followup 1 yr Survival 3 yr 5 j r Comments Prefer EF > 20; L V E D D < 70mm Louie (19 91) 22 • > CO 50 LVESVI< 10 0 ml 40 LVESVI> 10 0 ml 30 20 1 0 -1 1 0 6 — I — 12 18 1 24 30 36 Time (Months) Yiffirtft ("ompan son of survival for patients with "large" (l.VT.SM \ 10 0 ml) and "extra large ' fLmSV! 10 0 ml) hearts Only hospital survivors are tabulated As Ingurc 6 indicates, even the "extra large"... (19 93) 20 . whether or not we can demonstrate them by viability imaging. m 30 25 20 H 15 1 0- 5- EF Change (Pre- to Post-Operative) EF Change (Pre to Post-Operative) -1 5.0 -1 0.0 -5 .0 0.0 5.0 10 .0 15 .0. (mean) 23% - 15 .7% 22% 20% 18 % 23.5% 28% 23.8% - 23.5% Hospital Mortality 13 .6% 9.8% 4.8% 20% 11 % 8% 3.8% - 10 % 1. 7% 7 .1% 7% 5.3% Mean Followup 12 - 34 - - 44 65 43. the Treatment of Heart Failure. 1 5-3 1. & 19 99 Kluwer Academic Publishers. Printed in the Netherlands. 16 J.A^ Kkfteriades el aL 10 0 Natural Historf of Adwanced L¥ Dysfunction 0 1