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Septal anterior ventricular exclusion procedure for idiopathic dilated cardiomyopathy

Hisayoshi Suma1, Tadashi Isomura, Taiko Horii

  • 1The Cardiovascular Institute, Tokyo, Japan. suma@cvi.or.jp

The Annals of Thoracic Surgery
|September 26, 2006
PubMed

Insights

The septal anterior ventricular exclusion procedure offers a viable treatment for advanced idiopathic dilated cardiomyopathy, improving heart function and reducing ventricle size. This surgical option shows promising survival rates for patients with severely enlarged left ventricles.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Heart Failure Treatment

Background:

  • Idiopathic dilated cardiomyopathy (IDCMP) is a leading cause of congestive heart failure.
  • Advanced IDCMP often involves an extremely dilated left ventricle with an akinetic septum, posing significant therapeutic challenges.
  • The septal anterior ventricular exclusion (SAVE) procedure has been developed to address these specific structural abnormalities.

Purpose of the Study:

  • To evaluate the long-term efficacy and outcomes of the septal anterior ventricular exclusion (SAVE) procedure.
  • To assess the impact of SAVE combined with mitral reconstruction on cardiac function and patient survival.
  • To analyze the safety and effectiveness of SAVE in patients with advanced IDCMP and severely dilated left ventricles.

Main Methods:

  • A retrospective analysis of 36 patients (mean age 60 years) with advanced IDCMP (NYHA class III/IV) and severe left ventricular dilation (diastolic dimension ≥75 mm) undergoing SAVE procedure.
  • The SAVE procedure involved excluding the akinetic septum and anterior wall using a specially designed patch to downsize the left ventricle.
  • All patients underwent concomitant mitral reconstruction (repair or replacement), and 44% also received tricuspid valve repair.

Main Results:

  • Hospital mortality was 13.8%, with significantly lower rates in elective (6.5%) versus emergency (60%) operations.
  • Postoperative improvements included increased ejection fraction (20.9% to 27.5%), decreased left ventricular dimensions and volumes, and reduced filling pressures.
  • Significant reduction in Brain Natriuretic Peptide levels was observed. One- and 3-year survival rates were 67.5% and 60.7%, respectively, with survivors showing improved NYHA class (mean 1.7).

Conclusions:

  • The septal anterior ventricular exclusion procedure, when combined with mitral reconstruction, is an effective therapeutic option for advanced idiopathic dilated cardiomyopathy.
  • This surgical approach is particularly beneficial for patients with extremely dilated left ventricles and akinetic septa.
  • The SAVE procedure demonstrates potential for improving cardiac function, reducing heart failure symptoms, and enhancing long-term survival in carefully selected patients.
Abstract

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