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Related Experiment Videos

Left ventricular reconstruction for ischemic cardiomyopathy.

Vincent Dor1

  • 1Centre Cardio-Thoracique, Monaco. vdor@ccm.mc

Journal of Cardiac Surgery
|December 20, 2002
PubMed
Summary

Left ventricular reconstruction (LVR) using endoventricular circular patchplasty (EVCPP) improves heart function and geometry in patients with severe left ventricular damage. This surgical technique offers improved ejection fraction and can prevent heart failure, with decreasing mortality rates over time.

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Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery
  • Heart Failure Management

Background:

  • Left ventricular aneurysm or akinesia following myocardial infarction can lead to progressive heart failure.
  • Traditional medical therapy may be insufficient for end-stage ischemic cardiomyopathy.
  • Left ventricular reconstruction (LVR) using endoventricular circular patchplasty (EVCPP) has been utilized since 1984.

Purpose of the Study:

  • To evaluate the efficacy and safety of LVR by EVCPP in patients with significant left ventricular dysfunction.
  • To assess the impact of LVR on left ventricular geometry, ejection fraction, and long-term outcomes.
  • To identify factors influencing delayed impairment after LVR.

Main Methods:

  • LVR performed on a totally arrested heart with prior coronary revascularization.

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  • Mitral valve assessment and repair, endocardectomy, and cryotherapy for ventricular tachycardia as needed.
  • Placement of a circular patch using a balloon at the limit of scarred and normal tissue.

    • Main Results:

    • Global hospital mortality decreased from 7.3% (overall series) to 4.8% (last 3 years).
    • Mortality in patients with ejection fraction < 30% decreased from 13% to 7.9% in the recent series.
    • Mean ejection fraction increase of 10–15 points, with improved LV geometry and performance.

    Conclusions:

    • LVR by EVCPP is a valuable option for patients with large, asynergic scarred ventricles to prevent heart failure.
    • The procedure offers acceptable risk in end-stage ischemic cardiomyopathy, potentially delaying or avoiding heart transplantation.
    • Potential causes for delayed impairment include ongoing remodeling, inadequate diastolic capacity, or absence of mitral repair.