Comprehensive treatment of cardiac surgical patients with chronic left ventricular dysfunction_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Jian , ZHANG Wei , GU Weili ,  ZHU Dan

Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, P.R.China;

Corresponding author：

ZHU Dan, Email: zhudanmd@163.com

Keywords：

Heart failure; surgery; neuroendocrine inhibition theory

DOI：

10.7507/1007-4848.201707033

Video：

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Objective To explore the use of comprehensive treatment including drugs, devices and electrophysiology for heart failure patients with surgical indications. Methods We collected the clinical data of 65 consecutive cardiac surgical patients with chronic left ventricular dysfunction in our department between March 2014 and May 2016. There were 49 males and 16 females with an average age of 61.3±11.4 years ranging from 37 to 80 years. Their left ventricular ejection fraction was less than 40%. Patients with ventricular dysfunction caused by acute myocardial infarction were excluded. A comprehensive treatment strategy was performed according to patients’ individual disease.Results Fourty patients underwent cardiopulmonary bypass with asisting time of 55-400 (148.1±69.8) min; 35 patients needed cross-clamping with time of 44-203 (95.7±39.6) min. Intra-aortic balloon pump (IABP) was assisted in 3 patients. Two patients died in hospital. During the follow-up of 13.4 months, the patients’ cardiac function significantly improved and the heart size reduced. Two patients died and two were readmitted for heart failure. Four patients underwent cardiac pacemaker implantation. Other patients with unstable symptoms were stabilized after medical dose adjustment.Conclusion Under the concept of neuroendocrine inhibition, the comprehensive treatment for heart failure can effectively reduce surgical mortality and improve the patient’s quality of life.

Citation： LI Jian, ZHANG Wei, GU Weili, ZHU Dan. Comprehensive treatment of cardiac surgical patients with chronic left ventricular dysfunction. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(4): 313-316. doi: 10.7507/1007-4848.201707033 Copy

1.	Kristensen SL, Preiss D, Jhund PS, et al. Risk related to pre-diabetes mellitus and diabetes mellitus in heart failure with reduced ejection fraction: Insights from prospective comparison of ARNI with ACEI to determine impact on global mortality and morbidity in heart failure trial. circ heart fail, 2016, 9(1): pii: e002560.
2.	Chatterjee S, Biondi-Zoccai G, Abbate A, et al. Benefits of β blockers in patients with heart failure and reduced ejection fraction: network meta-analysis. BMJ, 2013, 346: f55.
3.	Miller SE, Alvarez RJ Jr. Aldosterone antagonists in heart failure. J Cardiovasc Nurs, 2013, 28(6): E47-E54.
4.	Russo AM, Stainback RF, Bailey SR, et al. ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 appropriate use criteria for implantable cardioverter-defibrillators and cardiac resynchronization therapy: a report of the American College of Cardiology Foundation appropriate use criteria task force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol, 2013, 61(12): 1318-1368.
5.	邹小明, 刘鑫, 李梅, 等. 重症心脏瓣膜病合并充血性心力衰竭外科治疗. 南方医科大学学报, 2009, 29(8): 1691-1692.
6.	Ziaeian B, Zhang Y, Albert NM, et al. Clinical effectiveness of CRT and ICD therapy in heart failure patients by racial/ethnic classification: insights from the IMPROVE HF registry. J Am Coll Cardiol, 2014, 64(8): 797-807.
7.	Crescenzi G, Pappalardo F, Rosica C, et al. Tricks and pitfalls regarding the hemodynamics of patients undergoing non-transplantation surgery for heart failure. Minerva Anestesiol, 2008, 74(12): 715-725.
8.	Kjaer A, Hesse B. Heart failure and neuroendocrine activation: diagnostic, prognostic and therapeutic perspectives. Clin Physiol, 2001, 21(6): 661-672.
9.	中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南 2014. 中华心血管病杂志, 2014, 42(2): 98-122.
10.	朱丹, 王哲, 陈安清, 等. 缺血性心肌病非移植外科治疗远期效果. 中华胸心血管外科杂志, 2010, 26(4): 224-226.
11.	Lüscher TF. Heart failure: focus on co-morbidities, inflammation, and heart rate. Eur Heart J, 2015, 36(11): 635-637.
12.	Keeling WB, Williams ML, Slaughter MS, et al. Off-pump and on-pump coronary revascularization in patients with low ejection fraction: a report from the society of thoracic surgeons national database. Ann Thorac Surg, 2013, 96(1): 83-88.
13.	Aleong RG, Sauer WH, Davis G, et al. New-onset atrial fibrillation predicts heart failure progression. Am J Med, 2014, 127(10): 963-971.
14.	MacDonald MR, Connelly DT, Hawkins NM, et al. Radiofrequency ablation for persistent atrial fibrillation in patients with advanced heart failure and severe left ventricular systolic dysfunction: a randomised controlled trial. Heart, 2011, 97(9): 740-747.
15.	Zhao L, Xu K, Jiang W, et al. Long-term outcomes of catheter ablation of atrial fibrillation in dilated cardiomyopathy. Int J Cardiol, 2015, 190: 227-232.
16.	Stulak JM, Dearani JA, Daly RC, et al. Left ventricular dysfunction in atrial fibrillation: restoration of sinus rhythm by the Cox-maze procedure significantly improves systolic function and functional status. Ann Thorac Surg, 2006, 82(2): 494-500.
17.	Henn MC, Lancaster TS, Miller JR, et al. Late outcomes after the Cox maze Ⅳ procedure for atrial fibrillation. J Thorac Cardiovasc Surg, 2015, 150(5): 1168-1176.
18.	Henry L, Durrani S, Hunt S, et al. Percutaneous catheter ablation treatment of recurring atrial arrhythmias after surgical ablation. Ann Thorac Surg, 2010, 89(4): 1227-1231.
19.	Sotomi Y, Inoue K, Ito N, et al. Cause of very late recurrence of atrial fibrillation or flutter after catheter ablation for atrial fibrillation. Am J Cardiol, 2013, 111(4): 552-556.

1. Kristensen SL, Preiss D, Jhund PS, et al. Risk related to pre-diabetes mellitus and diabetes mellitus in heart failure with reduced ejection fraction: Insights from prospective comparison of ARNI with ACEI to determine impact on global mortality and morbidity in heart failure trial. circ heart fail, 2016, 9(1): pii: e002560.
2. Chatterjee S, Biondi-Zoccai G, Abbate A, et al. Benefits of β blockers in patients with heart failure and reduced ejection fraction: network meta-analysis. BMJ, 2013, 346: f55.
3. Miller SE, Alvarez RJ Jr. Aldosterone antagonists in heart failure. J Cardiovasc Nurs, 2013, 28(6): E47-E54.
4. Russo AM, Stainback RF, Bailey SR, et al. ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 appropriate use criteria for implantable cardioverter-defibrillators and cardiac resynchronization therapy: a report of the American College of Cardiology Foundation appropriate use criteria task force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol, 2013, 61(12): 1318-1368.
5. 邹小明, 刘鑫, 李梅, 等. 重症心脏瓣膜病合并充血性心力衰竭外科治疗. 南方医科大学学报, 2009, 29(8): 1691-1692.
6. Ziaeian B, Zhang Y, Albert NM, et al. Clinical effectiveness of CRT and ICD therapy in heart failure patients by racial/ethnic classification: insights from the IMPROVE HF registry. J Am Coll Cardiol, 2014, 64(8): 797-807.
7. Crescenzi G, Pappalardo F, Rosica C, et al. Tricks and pitfalls regarding the hemodynamics of patients undergoing non-transplantation surgery for heart failure. Minerva Anestesiol, 2008, 74(12): 715-725.
8. Kjaer A, Hesse B. Heart failure and neuroendocrine activation: diagnostic, prognostic and therapeutic perspectives. Clin Physiol, 2001, 21(6): 661-672.
9. 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南 2014. 中华心血管病杂志, 2014, 42(2): 98-122.
10. 朱丹, 王哲, 陈安清, 等. 缺血性心肌病非移植外科治疗远期效果. 中华胸心血管外科杂志, 2010, 26(4): 224-226.
11. Lüscher TF. Heart failure: focus on co-morbidities, inflammation, and heart rate. Eur Heart J, 2015, 36(11): 635-637.
12. Keeling WB, Williams ML, Slaughter MS, et al. Off-pump and on-pump coronary revascularization in patients with low ejection fraction: a report from the society of thoracic surgeons national database. Ann Thorac Surg, 2013, 96(1): 83-88.
13. Aleong RG, Sauer WH, Davis G, et al. New-onset atrial fibrillation predicts heart failure progression. Am J Med, 2014, 127(10): 963-971.
14. MacDonald MR, Connelly DT, Hawkins NM, et al. Radiofrequency ablation for persistent atrial fibrillation in patients with advanced heart failure and severe left ventricular systolic dysfunction: a randomised controlled trial. Heart, 2011, 97(9): 740-747.
15. Zhao L, Xu K, Jiang W, et al. Long-term outcomes of catheter ablation of atrial fibrillation in dilated cardiomyopathy. Int J Cardiol, 2015, 190: 227-232.
16. Stulak JM, Dearani JA, Daly RC, et al. Left ventricular dysfunction in atrial fibrillation: restoration of sinus rhythm by the Cox-maze procedure significantly improves systolic function and functional status. Ann Thorac Surg, 2006, 82(2): 494-500.
17. Henn MC, Lancaster TS, Miller JR, et al. Late outcomes after the Cox maze Ⅳ procedure for atrial fibrillation. J Thorac Cardiovasc Surg, 2015, 150(5): 1168-1176.
18. Henry L, Durrani S, Hunt S, et al. Percutaneous catheter ablation treatment of recurring atrial arrhythmias after surgical ablation. Ann Thorac Surg, 2010, 89(4): 1227-1231.
19. Sotomi Y, Inoue K, Ito N, et al. Cause of very late recurrence of atrial fibrillation or flutter after catheter ablation for atrial fibrillation. Am J Cardiol, 2013, 111(4): 552-556.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comprehensive treatment of cardiac surgical patients with chronic left ventricular dysfunction

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