Surgical ventricular restoration to reverse left ventricular remodeling

Abstract

Heart failure is one of the major health care issues in the Western world. An increasing number of patients are affected, leading to a high rate of hospitalization and high costs. Even with administration of the best available medical treatment, mortality remains high. The increase in left ventricular volume after a myocardial infarction is a component of the remodeling process. Surgical Ventricular Restoration (SVR) has been introduced as an optional therapeutic strategy to reduce left ventricular volume and restore heart geometry. So far, it has been established that SVR improves cardiac function, clinical status, and survival in patients with ischemic, dilated cardiomyopathy and heart failure. Since its first description , SVR has been refined in an effort to standardize the procedure and to optimize the results. This review will discuss the rationale behind surgical reversal of LV remodeling, the SVR technique, its impact on cardiac function and survival, and future expectations.

Keywords: Diastolic function.; Left ventricular remodeling; Myocardial infarction; Surgical ventricular restoration; Systolic function.

Fig. (1)

Upper panel - The mannequin positioned inside the ventricle (Schematic); Lower panels - An image of the mannequin from the operating room (left); The circular suture follows the curvature of the mannequin to re-shape the ventricle in an elliptical manner. The patch is used to close the ventricular opening (right).

Fig. (2)

The plication at the inferolateral portion of the ventricle is useful to lift up the new apex.

Fig. (3)

An example of classic aneurysm showing an apical axis that is bigger than the short axis (systolic CI=1.15) (left). An example of ischemic dilated cardiomyopathy showing an apical axis that is smaller than the short axis (systolic CI= 0.72) (right).