Surgical Ventricular Restoration: Is There Any Difference in Outcome Between Anterior and Posterior Remodeling?

Garatti, Andrea; Castelvecchio, Serenella; Bandera, Francesco; Guazzi, Marco; Menicanti, Lorenzo

doi:10.1016/j.athoracsur.2014.07.076

Cited by 14 publications

(15 citation statements)

References 22 publications

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“…Conversely, in patients with previous anterior MI, MR occurs mainly in the setting of global LV dilatation and severe dysfunction, reflecting a more advanced stage of disease, with apical displacement of pupillary muscles causing tethering of both mitral valve leaflets [15]. From a retrospective analysis, we showed that preoperative severe MR was an independent predictor of late mortality in the anterior group but not in the posterior one [40]. However, regardless of the specific mechanism, we found an acceptable long-term survival for this challenging population, despite a high operative mortality rate (14.3%), still comparable with other series reported in the literature [39].…”

Section: What We Have Learned From the Pastmentioning

confidence: 99%

Myocardial reconstruction in ischaemic cardiomyopathy

Castelvecchio

Pappalardo

Menicanti

2019

European Journal of Cardio-Thoracic Surgery

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Summary An increase in left ventricular volume after a myocardial infarction is a key component of the adverse remodelling process leading to chamber dysfunction, heart failure and an unfavourable outcome. Hence, the therapeutic strategies have been designed to reverse the remodelling process by medical therapy, devices or surgical strategies. Surgical ventricular reconstruction primarily combined with myocardial revascularization has been introduced as an optional intervention aimed to reduce the left ventricle through resection of the scar tissue and is recommended in selected patients with predominant heart failure symptoms, and with myocardial scarring and moderate left ventricular remodelling. This review outlines the rationale and the technique for reconstructing the left ventricle and the possible indications for using that technique, based on experiences from the centre with the largest international experience. The major contributions in the literature are briefly discussed.

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Section: What We Have Learned From the Pastmentioning

confidence: 99%

Myocardial reconstruction in ischaemic cardiomyopathy

Castelvecchio

Pappalardo

Menicanti

2019

European Journal of Cardio-Thoracic Surgery

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“…Of note, although anterior infarcts are more strongly associated with a higher preoperative CI, they tend to have a higher SI as well when compared with posterior infarcts. Posterior infarcts, while not highly related to either shape measure, have larger preoperative atrial dimensions, RV dysfunction, pulmonary pressure, and MR 53 . Regardless of the more severe preoperative symptoms in posterior infarcts, SVR still had similar hemodynamic and clinical benefits in both groups 53 …”

Section: Ventricular Structurementioning

confidence: 86%

“…Posterior infarcts, while not highly related to either shape measure, have larger preoperative atrial dimensions, RV dysfunction, pulmonary pressure, and MR 53 . Regardless of the more severe preoperative symptoms in posterior infarcts, SVR still had similar hemodynamic and clinical benefits in both groups 53 …”

Section: Ventricular Structurementioning

confidence: 86%

“…Hemodynamic variables that measure systolic function are often at the forefront of SVR research, where SVR has consistently resulted in significant benefits when compared to other surgical options and medical management 52 . While most studies distinguish patients depending on infarct site, some researchers have shown that hemodynamic improvement in the form of left ventricular EF (LVEF) happens post SVR regardless of anterior or posterior sites 53,54 . Nevertheless, the vast majority of research focuses on the more common anterior region infarct as the source of dilation in ischemic cardiomyopathy.…”

Section: Ventricular Function and Volumementioning

confidence: 99%

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Clinical and hemodynamic outcomes of the Dor procedure in adults with ischemic cardiomyopathy

Hassanabad

Wiebe

Ali

2021

Journal of Cardiac Surgery

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Ischemic cardiomyopathy continues to be a major contributor to congestive heart failure, which places a significant burden on our healthcare system. Improving medications and different coronary revascularization strategies are the mainstays in the management of ischemic cardiomyopathy. Although medications and mechanical circulatory support are playing an ever‐increasing role, cardiac transplantation remains the gold standard for treating advanced heart failure. Given the small number of available and suitable donor hearts, transplantation is limited for the majority of patients. Surgical ventricular restoration has repeatedly been suggested as a viable alternative in managing heart failure in select patients, as it is believed that surgically returning the ventricle to its original dimensions is possible and associated with favorable outcomes. The purpose of this manuscript is to comprehensively review the current literature on various surgical strategies for ventricular restoration. We also contextualize the published data with respect to ventricular function, volume, structure, arrhythmias, mitral regurgitation, and clinical outcomes.

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“…Garratti and colleagues [1] should be complimented on the thorough follow-up of their large series of surgical ventricular restoration (SVR) patients. However, the retrospective nature and the lack of a control group subjected to surgical myocardial revascularization alone significantly limit the value of this study.…”

Section: Invited Commentarymentioning

confidence: 99%