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The IX t h Makassed Medical Congress - American University of Beirut

The IX t h Makassed Medical Congress - American University of Beirut

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ELECTOPHYSIOLOGY IN HEART FAILURE<br />

Oussama Musbah Wazni, MD<br />

As more patients with heart failure are being diagnosed and treated it is becoming more evident<br />

that these patients invariably need to be treated by electrophysiologists.<br />

In addition for the need <strong>of</strong> device therapy such as ICDs and CRTDs these patients frequently<br />

develop VT or recurrent ICD shocks. This is usually first treated with antiarrhythmics medications<br />

but also not infrequently these patients need EPS and ablation.<br />

Also patients with heart failure increasingly develop atrial fibrillation with worsening functional<br />

status and also worsening left ventricular function again in this group <strong>of</strong> patients AF ablation has<br />

been shown to be effective.<br />

In this session we will discuss in more depth the role <strong>of</strong> electrophysiological studies and ablative<br />

therapy in patients with heart failure.<br />

SURGICAL VENTRICULAR RESTORATION (SVR)<br />

THE EARLY EXPERIENCE IN SAUDI ARABIA<br />

Walid Abukhudair; E. Ahmed; A. Ajam; W. Ahmed;<br />

K. Shaibi; M. El-Hamami; A. Ashmeg<br />

Objectives: To evaluate our early experience with SVR as therapy for a subset <strong>of</strong> patients with<br />

ischemic cardiomyopathy.<br />

Background: Ischemic cardiomyopathy poses a challenging problem to the cardiologist and<br />

cardiac surgeons. Following myocardial infraction, 20% <strong>of</strong> patients develop ventricular dilation<br />

and congestive heart failure (CHF) even with early reperfusion therapy. This is due to “ventricular<br />

remodeling” process that results in the loss <strong>of</strong> the normal elliptical shape <strong>of</strong> the ventricle and CHF.<br />

Ventricular volume reduction, and shape restoration surgery has recently become an available<br />

option for this subset <strong>of</strong> patients. We prospectively examined the early outcome <strong>of</strong> SVR in our<br />

institution.<br />

Methods: Eight prospective post anterior myocardial infraction patients underwent SVR with<br />

concomitant CABG /or mitral valve repair are presented.<br />

We also reviewed the stich trial result in a critical EBM method.<br />

Results: 110 SVR patient were done between March 2006 to March 2010.<strong>The</strong> mean age was 50.6<br />

(+ 5.1) years. All patients were males. <strong>The</strong> mean left ventricular fraction was 20 % ± 3.16. One<br />

hundred patient had SVR with concomitant CABG. Thirty five patients had mitral valve repair as<br />

well. <strong>The</strong> average number <strong>of</strong> grafts was 2 + 0.63. <strong>The</strong> NYHA class has improved from 3.3 (+ 0.8) to<br />

1.8 + 0.4. <strong>The</strong> mean left ventricular ejection fraction improved from 20 + 3.16 to 30.8 + 5.8.<br />

<strong>The</strong> post-op ventilation period was 40 hours (+ 1.9) and the mean length <strong>of</strong> stay was 12.8 (+ 4.7)<br />

days. Intra aortic balloon pump (IABP) and Levosimendan were used in 40 patients. <strong>The</strong>re is one<br />

intra operative mortality and mortality rate was 5 %. STICH did not select same patient population<br />

and did not treat them the write way in terms <strong>of</strong> technique and LV reduction.<br />

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