Surgical left ventricular reconstruction

Abstract

Because of the shortage of donors for heart transplantation, surgical ventricular reconstruction (SVR) has been under development to treat end-stage heart failure due to a dilated left ventricle. The operative procedures have been developed and modified based on the clinical results and preoperative findings of several examinations. SVR is performed to reduce the size and volume of the ventricle as well as to reshape it. The procedures, which differ based on the particular left ventricular lesion, are endoventricular patch plasty or septal anterior ventricular restoration for anteroseptal exclusion and partial left ventriculectomy or a posterior restoration procedure for posterolateral exclusion. In the indicated patients, SVR has been emerging as an alternative to heart transplantation. The accumulating surgical knowledge may provide new opportunities for the treatment of ischemic dilated cardiomyopathy. The Surgical Treatment for Ischemic Heart Failure (STICH) trial seems to have arrived at a misguided conclusion. Surgeons have to know not only the operative procedures for SVR; they must also be aware of the systolic and diastolic functioning and the volume and size of the left ventricle before and after SVR. Hence, SVR is reviewed and discussed here.

Preoperative transaortic forward flow: Prediction of surgical outcomes in patients with DCM and mitral regurgitation

“…We have treated patients with endstage dilated cardiomyopathy (DCM) and functional MR using 3 types of surgical ventricular restoration (SVR) and mitral valve surgery. 7–9 In our experience, smaller postoperative LV volume with higher volume reduction rate might be one of the prognostic factors for late survival. 8,10 However, a preoperative prognostic factor is required for such critical patients.…”

Prediction of Long-Term Survival in Patients with End-Stage Heart Failure Secondary to Ischemic Heart Disease: Surgical Correction and Volumetric Analysis

“…We demonstrated that long-term survival rate in patients with smaller postoperative LVESVI was much higher compared with those with larger LV volume. 10,11) Additionally, another report also demonstrated that lower postoperative LVESVI was highly associated with midterm survival. 22,23) Thus, LVESVI less than 100 ml/m 2 would be one of possible predictors for long-term survival in patients with ICM and MR, despite the timing of the operation (preoperative and postoperative).…”

“…10,11) The purpose of SVR includes two major reasons such as reduction of LV volume and subvalvular procedures for functional MR. Earlier reports demonstrated that functional MR may result from dilation of the mitral annulus, laterally displaced papillary muscles, and enhanced tethering force of the valve leaflets in the hearts with dilated LV.…”

“…10,11) We used three types of SVR, including endoventricular circular patch plasty (EVCPP) for the antero-apical lesion, SAVE for the broad anterior lesion, and posterior restoration procedure (PRP) for the posterior lesion. In addition to SVR, cryoablation was performed for incision line to prevent postoperative ventricular arrhythmia.…”

“…10,11) A dilated LV with a focal akinetic lesion is a surgical indication for SVR, and the choice of procedure is determined by the location of the akinesis. Using this surgical strategy, we have treated critical patients with non-ischemic DCM such as muscular dystrophy and cardiac sarcoidosis, and demonstrated operative efficacies.…”