Surgical Treatment of Ischemic Dilative Cardiomyopathy by Ventricular Restoration

2021 ◽  
Author(s):  
Guglielmo Stefanelli ◽  
Clorinda Labia ◽  
Marco Meli ◽  
Andrea Barbieri ◽  
Luca Weltert
Keyword(s):  
Heart Failure ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Surgical Ventricular Restoration ◽  
Heart Failure Patients ◽  
Left Ventricular Chamber ◽  
Surgical Options ◽  
One Step ◽  
Ventricular Restoration

Patients with symptomatic post-ischemic dilative myocardiopathy of the left ventricle require, in selected cases, an operation to reshape and reduce the volume of the left ventricular chamber, in addition to surgical myocardial revascularization and mitral valve repair, with the aim of prolonging survival, improving the quality of life and minimizing the need for re-hospitalizations related to recurrent heart failure. This procedure is called surgical ventricular restoration (SVR), and is a useful tool for the treatment of heart failure patients as an alternative to heart transplant. This article provides an overview of surgical ventricular restoration for the treatment of dilative ischemic myocardiopathy. It illustrates several surgical options, describes the operative details, and discusses the correct indications for the procedure. Finally, an interesting protocol for one-step cell therapy during SVR is proposed, as an innovative treatment for heart failure patients.

P6325Gas exchange improvements during exercise correlate with hemodynamic changes in heart failure patients with a left ventricular assist device

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Seuthe ◽  
M Morosin ◽  
H Smail ◽  
F Gerhardt ◽  
A Simon ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Cardiopulmonary Exercise Test ◽  
Left Ventricular ◽  
Peak Oxygen Consumption ◽  
Ventricular Assist ◽  
Heart Failure Patients ◽  
Left Ventricular Assist

Abstract Background The implantation of left ventricular assist devices (LVAD) has established its role in therapy for patients with end stage heart failure. Benefits in survival as well as an improved quality of life, compared to optimized medical therapy (OMT) alone, has been proven. There are limited data in the literature on the metabolic changes during exercise in LVAD patients, and in most studies no increase in peak oxygen consumption on cardiopulmonary exercise test (CPET) could be shown early after surgery. However, recent data suggests an improvement in peak oxygen uptake (VO2) as a late effect after rehabilitation. To further investigate these findings we sought to analyse CPET data from patients before LVAD implantation as well as in the early and late follow up in correlation with hemodynamic changes at these times. Methods We collected and retrospectively analysed data of heart failure patients who had undergone LVAD implantation, and in whom a right heart catheterization, a cardiopulmonary exercise test and an echocardiography had been performed at time before, as well as 6 Months and 12 months after LVAD implantation, respectively. Results Data of 43 patients implanted with an LVAD between 2011 and 2017 were analysed. There was significant improvement in cardiac output (3,2 vs 4,3 L/min, p<0,001) and VE/VCO2 slope (46 vs 38, p=0,001) 6 months after LVAD implant as well as a significant reduction in PCWP (26 vs 11 mmHg, p<0,001), PAP mean (40 vs 22 mmHg, p<0,001), RA mean (12 vs 8 mmHg, p=0,002) and PVR (4,2 vs 2,5 WU, p<0,001). However, there was no significant increase in peak VO2 after 6 months. 12 months after LVAD implantation there were no further significant changes in cardiac output, intracardiac pressures or VE/VCO2 slope, which all remained similar to the 6 months follow up. However, at that point, a significant increase in peak VO2 was seen, compared to baseline (1060 vs 1410ml/min, p=0,001) and to 6 months after surgery (Figure 1). Conclusion Cardiac output increases in heart failure patients early after LVAD implantation. Consequently, permanent ventricular off loading results in the reduction of intracardiac pressures and improvement in the VE/VCO2 slope 6 months after surgery. However, a significant rise in peak oxygen consumption could only be noted 12 months after surgery, suggesting either a delayed long-term effect of improved hemodynamics or other causes such as enhanced mobility or training due to improved quality of life.

scholarly journals Myocardial collagen turnover after surgical ventricular restoration in heart failure patients

2011 ◽  
Vol 13 (11) ◽  
pp. 1202-1210 ◽  
Author(s):  
Ellen A. ten Brinke ◽  
Tomasz G. Witkowski ◽  
Victoria Delgado ◽  
Patrick Klein ◽  
Margreet Klok ◽  
...  
Keyword(s):  
Heart Failure ◽  
Collagen Turnover ◽  
Surgical Ventricular Restoration ◽  
Heart Failure Patients ◽  
Myocardial Collagen ◽  
Ventricular Restoration

scholarly journals Surgical Ventricular Restoration (SVR) - Hope for Heart Failure Patients or is it a Dilemma?

1970 ◽  
Vol 2 (2) ◽  
pp. 118-120
Author(s):  
F Ahmed ◽  
M Sharifuzzaman ◽  
PK Chanda
Keyword(s):  
Heart Failure ◽  
Surgical Ventricular Restoration ◽  
Heart Failure Patients ◽  
Ventricular Restoration

DOI: 10.3329/cardio.v2i2.6626Cardiovasc. j. 2010; 2(2) : 118-120

2007 Katharine A. Lembright Award and Lecture—Stage D Heart Failure: Quality-of-Life Outcomes After Transplantation and Mechanical Support

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kathleen Grady
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Psychological Distress ◽  
Heart Transplantation ◽  
Functional Disability ◽  
Left Ventricular ◽  
Heart Failure Patients ◽  
Improved Outcomes ◽  
Stage D

Approximately 5 million individuals have heart failure in the United States. The 1-year mortality rate for patients with New York Heart Association class IV heart failure is 50%. Treatment options for patients with refractory symptoms and stage D heart failure include heart transplantation and mechanical circulatory support devices. Improved outcomes have been demonstrated in these advanced heart failure patients who undergo surgical therapies. Prolongation of life is relevant only if quality of life (QOL) is improved. Improvement in QOL outcomes has been demonstrated before and after heart transplantation, including improved outcomes when bridged to transplantation with left ventricular assist devices (LVADs). While listed for transplantation, worse QOL is significantly related to more symptoms, psychological distress, and functional disability. Patients who are bridged to heart transplantation with an LVAD report significantly improved QOL and decreased symptoms from before to early after LVAD implantation, as well as fairly good and stable QOL outcomes through 1 year after implantation. At 1 year after transplantation, better QOL is significantly related to less psychological distress, functional disability, and symptom distress; older age; and fewer complications. At 5 to 10 years after heart transplantation, QOL is positive and stable. Improved QOL is significantly related to biopsychosocial variables, including less depression, more positive emotions, more social support, and less fatigue. Thus, for stage D heart failure patients, heart transplantation conveys significant short-and long-term QOL benefit, including in those patients who are bridged to transplantation with an LVAD.

scholarly journals Analysis of patient-specific surgical ventricular restoration: importance of an ellipsoidal left ventricular geometry for diastolic and systolic function

2013 ◽  
Vol 115 (1) ◽  
pp. 136-144 ◽  
Author(s):  
Lik Chuan Lee ◽  
Jonathan F. Wenk ◽  
Liang Zhong ◽  
Doron Klepach ◽  
Zhihong Zhang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Negative Impact ◽  
Systolic Function ◽  
Left Ventricular ◽  
Magnetic Resonance Images ◽  
Left Ventricular Geometry ◽  
Patient Specific ◽  
Surgical Ventricular Restoration ◽  
Ventricular Restoration

Surgical ventricular restoration (SVR) is a procedure designed to treat heart failure by surgically excluding infarcted tissues from the dilated failing left ventricle. To elucidate and predict the effects of geometrical changes from SVR on cardiac function, we created patient-specific mathematical (finite-element) left ventricular models before and after surgery using untagged magnetic resonance images. Our results predict that the postsurgical improvement in systolic function was compromised by a decrease in diastolic distensibility in patients. These two conflicting effects typically manifested as a more depressed Starling relationship (stroke volume vs. end-diastolic pressure) after surgery. By simulating a restoration of the left ventricle back to its measured baseline sphericity, we show that both diastolic and systolic function improved. This result confirms that the increase in left ventricular sphericity commonly observed after SVR (endoventricular circular patch plasty) has a negative impact and contributes partly to the depressed Starling relationship. On the other hand, peak myofiber stress was reduced substantially (by 50%) after SVR, and the resultant left ventricular myofiber stress distribution became more uniform. This significant reduction in myofiber stress after SVR may help reduce adverse remodeling of the left ventricle. These results are consistent with the speculation proposed in the Surgical Treatment for Ischemic Heart Failure trial ( 20 ) for the neutral outcome, that “the lack of benefit seen with surgical ventricular reconstruction is that benefits anticipated from surgical reduction of left ventricular volume (reduced wall stress and improvement in systolic function) are counter-balanced by a reduction in diastolic distensibility.”

scholarly journals Effect of Left Ventricular Restrictive filling pattern on survival in ischemic cardiomyopathy: Implications for surgical ventricular restoration.

2021 ◽  
Author(s):  
srilakshmi adhyapak ◽  
Tinku Thomas ◽  
Tivlin Maria ◽  
Kiron Varghese
Keyword(s):  
Heart Failure ◽  
Pilot Study ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular ◽  
Advanced Heart Failure ◽  
Left Ventricular Ejection ◽  
Surgical Ventricular Restoration ◽  
Ventricular Ejection Fraction ◽  
Filling Pattern ◽  
Ventricular Restoration

Background: To evaluate the effects of baseline left ventricular restrictive filling pattern (RFP; E/A>2) in ischemic cardiomyopathy (ICM) patients on prognosis. Methods: Patient data was retrospectively analyzed over a period of 4.5 years to determine the effect of Echocardiographic factors on survival and re-admission for heart failure. Results: There were 102 ICM patients who had baseline RFP. We identified two sub-groups based on geometric phenotypes of left ventricular eccentric remodeling and dilated remodeling based on the relative wall thickness (RWT >0.34 or <0.34). The patients with preserved RWT had significantly more dilated ventricles ( LVIDd and LVIDs), greater pulmonary artery systolic pressures (PASP), greater diatolic dysfunction (E/A) and less left ventricular ejection fraction (LVEF); p<0.001. The number of deaths was higher in the reduced RWT patients, as were the number of re-admissions, although the time to survival and time to re-admission was not significant. Conclusions: In this pilot study on ICM patients in advanced heart failure with baseline RFP, the presence of preserved RWT indicative of eccentric remodelling demonstrated a better clinical outcome, leading to a hypothesis that the eccentric remodelling LV phenotype might benefit with SVR.

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