Non txp options for heart failure

Question 1

Indication for surgery for LV aneurysm

Answer 1

An LV aneurysm in the setting of CHF, embolism, or arrhythmia is an indication for surgery.

Question 2

General contraindications for surgery for LV aneurysm surgery

Answer 2

To benefit from surgery, the patient should not have:

1. severe RV dysfunction
2. LV cavity that is so small that volume reduction would compromise stroke volume.

Question 3

RESTORE Trial
what was it?
what were the benefits?
concomitant procedures?

Answer 3

The RESTORE (Reconstructive Endoventricular Surgery returning Torsion Original Radius Elliptical shape the LV) group pub lished the most well known study related to SVR.

Post op improvements:
EF, NYHA class, and LV end- systolic volume improved postoperatively.

Of note, 95% and 22% of patients underwent concomitant CABG and mitral valve repair, respectively.

Question 4

RESTORE -

what pre op risk factors were found

Answer 4

Preoperative risk factors that increase long-term mortality include older age, degree of CHF, EF 20 mmHg, and presence of MR.

The degree of residual myocardial function is important to determine overall improvement after surgery.

Question 5

Is thrombus an indication for LV aneurysm surgery

Answer 5

No - rarely embolisms

Question 6

Effect of beta blockers on VO2

Answer 6

Beta-blockers reduce mortality in patients with heart failure without influencing peak VOÍ.

Question 7

Heart Failure Survival Score

• elements ? (7)
• what constitutes and indication for txp?

Answer 7

HFSS includes:

1. presence or absence of coronary artery disease
2. resting heart rate
3. LV ejection fraction
4. mean arterial blood pressure
5. presence or absence of intraventricular conduction defect on baseline ECG
6. peak VO2
7. serum sodium.

a HFSS

Question 8

Improvement in survival in patients with CHF and CAD

Answer 8

25 years that revascularizing patients with left ventricular dysfunction can result in upward of a25% improvement in long-term survival

Question 9

Conditions which should indicate caution for low EF revascularization

Answer 9

Nevertheless, patients with clear documentation of a:
poor right ventricular EF,
clinical right-sided congestive symptoms, or fixed pulmonary hypertension above 60 mm Hg systolic should be approached cautiously, because these patients may in fact be better suited for transplantation.

Question 10

5 year survival for OMM vs Txp vs CABG for low EF

Answer 10

The 5-year survival
transplantation ranges: 62 to 82%,
OMM: 20%.
CABG for ischemic cardiomyopathy ranging from 85 to 88% at 1 year, 75 to 82% at 2 years, 68 to 80% at 3 years, and 60 to 80% at 5 years.

Question 11

Operative mortality for CABG with ischemic cardiomyopathy?

what is the main predictor?

Answer 11

Operative mortality has been reported from 3 to 12%, with the main predictor of increased risk being urgency of operation.

Question 12

Functional improvements with CABG for ischemic cardiomyopathy

Answer 12

When compared to medical therapy, revascularized patients have significant improvements in quality of life. Most series consistently report considerable enhancements in patient mobility, peak oxygen consumption, and functional status.

The average preoperative NYHA class of 3.5 reportedly drops to 1.5 after revascularization.

Postoperatively, there are substantial reductions in readmissions for CHF and many patients return to work.

Question 13

AP diamater and the efficacy of a mitral repair

Answer 13

perhaps, the strongest predictor of CHF MVR failure is anterior-posterior (AP) diameter greater than 3.7 cm.51 When the AP diameter after annuloplasty is greater than 3.7 cm the repair should be considered as a potential predictor of a failed repair