Table Of ContentManagement of Heart Failure
Management of Heart Failure
Volume 2: Surgical
Edited by
Jai Raman
University of Chicago, Chicago, USA
Jai Raman, MBBS, MMed (Syd), FRACS, PhD (Melb)
Professor of Surgery
Director of Adult Cardiac Surgery
University of Chicago
Chicago, IL, USA
ISBN: 978-1-84800-103-9 e-ISBN: 978-1-84800-104-6
DOI: 10.1007/978-1-84800-104-6
British Library Cataloguing in Publication Data
Management of heart failure
Vol. 2: Surgical
1. Heart failure - Treatment
I. Raman, Jai
616.1'2906
ISBN-13: 9781848001039
Library of Congress Control Number: 2008920050
© Springer-Verlag London Limited 2008
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On June 4, 2007, a small plane carrying the University of Michigan thoracic
organ transplant team crashed into Lake Michigan, soon after takeoff from
Milwaukee, Wisconsin. These were the members of that team and they epitomize
many unsung heroes who make up the teams that work in the field of heart
failure and transplantation:
Dr Martinus “Martin” Spoor, a cardiac surgeon who had been on the
faculty since 2003 at the University of Michigan.
Dr David Ashburn, a fellow in pediatric cardiothoracic surgery.
Richard Chenault II, a transplant donation specialist with the university
transplant program.
Richard Lapensee, a transplant donation specialist with the university
transplant program.
Dennis Hoyes, a Marlin air pilot.
Bill Serra, a Marlin air pilot.
This publication is dedicated to their memory. We would like to dedicate
these two volumes of the book to the many healthcare givers of various
persuasions who look after patients and facilitate the delivery of care. We
also dedicate this effort to the numerous pioneers in the realm of heart
failure research and development.
Preface
As I sit here, thinking about the field of heart amazing that coronary artery surgery became the
f ailure, what springs to mind are the unsung heroes most commonly performed surgical procedure
who pervade the arena. Right from transplant toward the end of the twentieth century. However,
coordinators to rehabilitation therapists, from heart as less invasive options of angioplasty and stent-
failure cardiologists to transplant surgeons, critical ing became more widespread, more and more
care physicians to transplant pharmacists, etc. All patients were able to survive heart attacks. These
this becomes more personal, in light of the recent patients then had more attention paid to their
plane crash in the mid-west of the USA, when an cardiovascular risks and longevity improved. The
entire team from the University of Michigan lost cost of all this improved survival is heart failure
their lives after they had harvested a set of thoracic of varying degrees. So much so, that heart fail-
organs. Even more poignant was the fact that Dr ure is the most common DRG code for hospital
Martinus Spoor, who contributed to a chapter in admissions in the developed world. The emer-
this book, lost his life in that crash. Therefore, this gence of heart failure as a specialty began with
is dedicated to his memory and many more like acceptance of heart transplantation and the use
him who have not been widely recognized. of immunosuppression. However, alternative and
Let us start with transplantation of the heart delaying techniques to transplantation along with
itself. Even though Christiaan Barnard set the better drug therapy have built this whole specialty
world on fire with the successful heart transplant into a multidisciplinary behemoth. We have a
in 1967, it was the hard work of people like range of options in the therapy of heart failure,
Norman Shumway who over the years built the ranging from medications to special techniques of
science and many teams that made cardiac trans- resynchronization, venous ultrafiltration, beating
plantation a success. In the same vein, the tireless heart surgery, etc.
efforts of Vincent Dor should not go unsung. Coronary artery surgery numbers declined but
I remember many meetings when he would get up patients who now present for bypass surgery invari-
and present his data on geometric left ventricular ably have some degree of left ventricular dysfunc-
reconstruction. The initial skepticism of the audi- tion and more diffuse disease. They are often on
ence gave way to credulous acceptance only over aspirin and plavix. As survivors of major and minor
a period of two decades. It is remarkable that the cardiac events, these veterans of hospital admissions
patience and persistence of pioneers like him, and multiple interventions pose great management
secure in their clinical and scientific observation, challenges that require coordination between a mul-
have paved the way for other practitioners to fol- titude of caregivers and practitioners.
low. This has helped in the formation of heart As the teams that look after these complex
failure as a specialty. When one considers that patients grow, so do the number of unsung heroes
Billroth exhorted in the late 1800s that surgery who perform tirelessly to improve the outcomes
on the heart was foolhardy and dangerous, it is of these sick patients. Remember, all this happens
vii
viii Preface
while the media is constantly talking about new My task here is therefore to acknowledge all those
stem cell therapies, new robotic operations, new unsung heroes around the world and thank them for
drugs for heart failure, etc. Very little mention their work. I would also like to thank all the contribu-
is made about the nitty-gritty and daily grind tors to this book, which is the first two-volume effort
of mundane tasks such as cardiac rehabilita- in the realm of heart failure. Grant Weston deserves
tion after a heart attack or cardiac surgery that credit, as the editor from Springer who had the fore-
dramatically improves the well-being of heart sight to hang his shingle on a “higher than usual risk”
failure patients. Few lay people know about the publication. No doubt there are areas of these two
existence of perfusionists who run the heart lung volumes that could be improved upon or updated,
machine in open heart surgery or manage those but our aim was to provide a good overview of the
large ventricular assist devices that keep patients Comprehensive Management of Heart Failure.
alive. The ensemble approach of having a team
look after patients for various aspects of care in Jai Raman
a coordinated fashion has resulted in many of Chicago, IL
these patients doing well. October 2007
Contents
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
1 Surgical Perspectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Jai Raman
2 Pathophysiology—Clinical Spectrum and Current Management . . . . . . . . . . . . . . . . . . . . 11
Mahesh P. Gupta and Jai Raman
3 Strategies in Surgical Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Irving L. Kron, R. Ramesh Singh, James D. Bergin, and Benjamin B. Peeler
4 Advanced Heart Failure: Transplant vs Nontransplant Surgical Options . . . . . . . . . . . . . 41
Stephen Westaby and Gabriele Bertoni
5 Transplantation for End-Stage Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
David C. McGiffin and James K. Kirklin
6 OPCAB Treatment for Heart Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Mercedes Dullum and Jai Raman
7 Circulatory Support for Bridging to Recovery or Transplantation. . . . . . . . . . . . . . . . . . . 111
Francis D. Pagani
8 Left Ventricular Reconstruction in Ischemic Cardiomyopathy . . . . . . . . . . . . . . . . . . . . . . 137
Salim Aziz, Constantine Athanasuleas, and Jai Raman
9 Modifications of the Dor Procedure and Failure Modes of the Procedure . . . . . . . . . . . . . 153
Jai Raman
10 Mitral Valve Repair. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Yoshikazu Suzuki, Martinus T. Spoor, and Steven F. Bolling
ix
x Contents
11 Destination Therapy with Permanent Mechanical Circulatory Assist Devices. . . . . . . . . . 181
Murali Macherla and Valluvan Jeevanandam
12 Enabling Techniques and Technologies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Patricia Gramling-Babb, Valluvan Jeevanandam, Jai Raman, David Song,
Hilton M. Hudson II, and John Paul Williams
13 Catheter-Based and Surgical Therapy for Ventricular Tachycardia. . . . . . . . . . . . . . . . . . 215
Bradley P. Knight, J. Massen, Gil Bolotin, and Jai Raman
14 Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure . . . . . . . . . . . . . . 221
Bradley P. Knight
15 Surgical Therapy for Atrial Fibrillation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
G. Bolotin and J.G. Maessen
16 Pacing Therapies, Defibrillators, and Post-Operative Arrhythmias . . . . . . . . . . . . . . . . . . 233
Bradley P. Knight
17 Ventricular Containment, Shape Change, and Infarct Restraint. . . . . . . . . . . . . . . . . . . . . 239
Jai Raman
18 Other Techniques in Special Circumstances: Pulmonary
Thromboendarterectomy in Right Heart Failure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Michael M. Madani and Stuart W. Jamieson
19 Surgical Management of Pediatric Heart Failure and Heart Failure
due to Congenital Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Emile A. Bacha
20 Anesthetic Management and Hemodynamic Management. . . . . . . . . . . . . . . . . . . . . . . . . . 269
Mark A. Chaney
21 Perioperative and ICU Care, Fluid Management, and Renal Support . . . . . . . . . . . . . . . . 279
Rinaldo Bellomo and Patrick Murray
22 New Therapies and What Is on the Horizon. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Keiichi Tambara and Masashi Komeda
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Contributors
Salim Aziz, MD Vincent Dor, M.D.
Clinical Professor of Surgery, George Department of Thoracic and Cardiac Surgery,
Washington University, Washington Centre Cardiothoracique de Monaco, Monte-
DC, USA Carlo, Monaco
Emile A. Bacha, M.D. Mercedes Dullum, M.D.
Department of Cardiac Surgery, Children’s Department of Cardiothoracic Surgery,
Hospital Boston, Boston, MA, USA Vleveland Clinic Florida, Weston, FL, USA
Rinaldo Bellomo, M.D. A. Eker, M.D.
Department of Intensive Care and, Austin Department of Thoracic and Cardiac Surgery,
Hospital, Melbourne, VIC, Australia Centre Cardiothoracique de Monaco,
Monte-Carlo, Monaco
James D. Bergin, M.D.
Department of Heart Failure and Patricia Gramling-Babb, M.D.
Heart Transplantation, University of Chief of Cardiac Anesthesia, Jacksonville Medical
Virginia Health Sciences Center, Center, Jacksonville, Florida, FL, USA
Charlottesville, VA, USA
Mahesh P. Gupta, Ph.D.
Gabriele Bertoni, M.D. Department of Cardiac and Thoracic Surgery,
Department of Cardiothoracic Surgery, The University of Chicago, Chicago, IL, USA
John Radcliffe Hospital, Oxford, UK
Hilton M. Hudson II, M.D.
Steven F. Bolling, M.D. Department of Cardiothoracic Surgery,
The University of Michigan, Section of Cardiac Franciscan Physicians Hospital,
Surgery, Taubman Health Care Center, Ann Munster, IN, USA
Arbor, MI, USA
Stuart W. Jamieson, M.B., F.R.C.S.
Gil Bolotin, M.D., Ph.D. Division of Cardiothoracic Surgery, University of
Department of Cardiac Surgery, California San Diego Medical Center, San Diego,
Rambam Medical Center, Haifa, Israel CA, USA
Mark A. Chaney, M.D. Valluvan Jeevanandam, M.D.
Department of Anesthesia and Critical Care, Department of Cardiothoracic Surgery, University
University of Chicago, Chicago, IL, USA of Chicago, Chicago, IL, USA
Filippo Civaia, M.D. James K. Kirklin, M.D.
MRI and CT Scan Department, Centre Surgery and Cardiothoracic Transplantation,
Cardiothoracique de Monaco, Monte-Carlo, University of Alabama at Birmingham,
Monaco Birmingham, AL, USA
xi
xii Contributors
Bradley P. Knight, M.D. Benjamin B. Peeler, M.D.
Department of Cardiac Electrophysiology, Department of Surgery, University of Virginia
University of Chicago, Chicago, IL, USA Health Sciences Center, Charlottesville, VA, USA
Masashi Komeda, M.D., Ph.D. Jai Raman, M.B.B.S., M.Med. (Syd),
Department of Cardiovascular Surgery, F.R.A.C.S., Ph.D. (Melb)
Graduate School of Medicine, Department of Cardiac Surgery,
Kyoto University, Kyoto, Japan University of Chicago, Chicago, IL, USA
Irving L. Kron, M.D. Mohamed Saab, M.D.
Department of Surgery, Department of Thoracic and Cardiac Surgery,
University of Virginia Health Sciences Center, Centre Cardiothoracique de Monaco,
Charlottesville, VA, USA Monte-Carlo, Monaco
Murali Macherla, M.D. Michael Sabatier, M.D.
Cardiothoracic Surgeon, Albuquerque, NM, USA Department of Thoracic and Cardiac Surgery,
Centre Cardiothoracique de Monaco,
Michael M. Madani, M.D.
Monte-Carlo, Monaco
Department of Cardiothoracic Surgery,
University of California, San Diego, CA, USA R. Ramesh Singh M.B., BCh, A.F.R.C.S.I.
University of Virginia Health Sciences Center,
J. G. Maessen, M.D.
Charlottesville, VA, USA
Chief of Cardiothoracic Surgery,
University of Maastricht, The Netherlands David Song, M.D.
Department of Plastic Surgery, University of
Komeda Masashi
Chicago, Chicago, IL, USA
Department of Cardiovascular Surgery,
Graduate School of Medicine, Martinus T. Spoor, M.D.†
Kyoto University, Kyoto, Japan The University of Michigan, Section of Cardiac
Surgery, Taubman Health Care Center,
David C. McGiffin, M.D.
Ann Arbor, MI, USA
Department of Surgery, University of Alabama at
Birmingham, Birmingham, AL, USA Yoshikazu Suzuki, M.D.
Section of Cardiac Surgery, Department of
Francois Montiglio, M.D.
Surgery, University of Michigan Cardiovascular
ICU of Cardiothoracic Surgery, Centre
Center, Ann Arbor, MI, USA
Cardiothoracique de Monaco, Monte-Carlo,
Monaco Keiichi Tambara, M.D., Ph.D.
Department of Cardiovascular Surgery,
Patrick Murray, M.D.
Graduate School of Medicine, Kyoto University,
Department of Medicine, Section of
Kyoto, Japan
Nephrology,University of Chicago Hospitals,
Chicago, IL, USA Stephen Westaby
Department of Cardial Surgery, John Radcliffe
Francis D. Pagani, M.D., Ph.D.
Hospital, Oxford, UK
Department of Surgery, University of Michigan
Medical Center, Ann Arbor, MI, USA John Paul Williams, M.D.
