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Surgical Ventricular Restoration: The RESTORE Group Experience

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Abstract

Congestive heart failure may be caused by late left ventricular (LV) dilation following anterior infarction. Early reperfusion prevents transmural necrosis, and makes the infarcted segment akinetic rather than dyskinetic. Surgical ventricular restoration (SVR) reduces LV volume and creates a more elliptical chamber by excluding scar in either akinetic or dyskinetic segments.

The international RESTORE group applied SVR in a registry of 1198 post-infarction patients between 1998 and 2003. Early and late outcomes were examined and risk factors identified.

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 < .001) Perioperative mechanical support was uncommon (< 9%).

Global systolic function improved postoperatively, as ejection fraction increased from 29.6 ± 11.0% to 39.5 ± 12.3% (p < .001) and left ventricular end systolic volume index decreased from 80.4 ± 51.4 ml/m2 to 56.6 ± 34.3 ml/m2 (p < .001). Overall 5-year survival was 68.6 ± 2.8%, Logistic regression analysis identified EF ≤ 30%, LVESVI ≥ 80 ml/m2, advanced 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 class III or IV, and postoperatively 85% were class I or II.

SVR improves ventricular function and is highly effective therapy in the treatment of ischemic cardiomyopathy with excellent 5-year outcome.

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Author information

Authors and Affiliations

  1. The Norwood Clinic, 1528 Carraway Boulevard, Birmingham, AL, 35242

    Constantine L. Athanasuleas MD

  2. David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 62-258 CHS, Los Angeles, CA, 90095-1741

    Gerald D. Buckberg MD

  3. Centre Cardio-thoracique de Monaco, Monte Carlo, Monaco

    Vincent Dor MD

  4. University of Florence, Florence, Italy

    Marisa Di Donato MD & Lorenzo Menicanti MD

  5. Istituto Policlinico San Donato, Milano, Italy

    Sergio Almeida de Oliveira MD

  6. Albert Ludwigs Universitat Freiburg, Freiburg, Germany

    Friedhelm Beyersdorf MD

  7. University of Virginia, Charlottesville, VA

    Irving L. Kron MD

  8. Hayama Heart Center, Kanagawa, Japan

    Hisayoshi Suma MD

  9. St. Louis, Missouri

    Nicholas T. Kouchoukos MD

  10. Orlando, Florida

    Wistar Moore MD

  11. The Cleveland Clinic Foundation, Cleveland, Ohio

    Patrick M. McCarthy MD

  12. Columbia University, NY, NY

    Mehmet C. Oz MD

  13. Bordeaux, France

    Francis Fontan

  14. Orlando, Florida

    Meredith L. Scott MD & Kevin A. Accola MD

  15. University of Sao Paulo Medical School, Sao Paulo, Brazil

    Sergio Almeida de Oliveira MD

  16. David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 62-258 CHS, Los Angeles, CA, 90095-1741, USA

    Gerald D. Buckberg MD

Authors
  1. Constantine L. Athanasuleas MD
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  2. Gerald D. Buckberg MD
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  3. Alfred W. H. Stanley MD
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  4. William Siler PhD
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  5. Vincent Dor MD
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  6. Marisa Di Donato MD
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The RESTORE Group

Corresponding author

Correspondence to Gerald D. Buckberg MD.

Additional information

See the Appendix for the list of members of RESTORE Group.

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Athanasuleas, C.L., Buckberg, G.D., Stanley, A.W.H. et al. Surgical Ventricular Restoration: The RESTORE Group Experience. Heart Fail Rev 9, 287–297 (2005). https://doi.org/10.1007/s10741-005-6805-4

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