Beating-heart ascending aortic graft replacement in dilated cardiomyopathy

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Implantation of the Syncardia Total Artificial Heart
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Hiroshi Imagawa1, Fumiaki Shikata, Masahiro Ryugo

  • 1Organ Regenerative Surgery, Ehime University School of Medicine, To-on, Ehime 791-0295, Japan. imagawa@m.ehime-u.ac.jp

Interactive Cardiovascular and Thoracic Surgery
|May 5, 2009
PubMed

Insights

Operating on a beating heart is challenging for dilated cardiomyopathy (DCM) patients. This case study demonstrates a successful ascending aorta replacement and cardiac resynchronization therapy implantation on a beating heart in a DCM patient.

Area of Science:

  • Cardiovascular Surgery
  • Cardiology

Background:

  • The optimal surgical approach for patients with dilated cardiomyopathy (DCM) and ascending aortic aneurysm remains debated.
  • Patients with severe left ventricular (LV) dysfunction and dyssynchrony present unique surgical challenges.

Observation:

  • A 73-year-old male with ascending aortic aneurysm and DCM (ejection fraction 16.5%) underwent aortic graft replacement.
  • The procedure involved LV lead implantation for cardiac resynchronization therapy (CRT).

Findings:

  • The surgery was successfully performed on a beating heart using tepid hypothermic cardiopulmonary bypass.
  • Antegrade/retrograde coronary blood perfusion was maintained during proximal anastomosis.
  • The patient experienced an uneventful postoperative recovery, with transient brain natriuretic peptide (BNP) elevation.

Implications:

  • This case suggests that complex cardiac surgery, including aortic repair and CRT implantation, can be safely performed on a beating heart in select DCM patients.
  • Beating-heart surgery may offer an alternative approach, potentially preserving cardiac function in high-risk populations.
  • Further research is warranted to establish the long-term outcomes and benefits of this technique.

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