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Published on: October 11, 2024
Overlapping left ventricular restoration
1Department of Cardiovascular Surgery, Hokkaido University Hospital, Sapporo, Japan.
Insights
Surgical ventricular restoration (SVR) offers alternatives for heart failure when transplantation is not feasible. Novel techniques like overlapping ventriculoplasty may serve as crucial bridges to cardiac transplantation.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Cardiac transplantation is a last resort for refractory heart failure, limited in Japan by donor shortages.
- Surgical ventricular restoration (SVR) presents an alternative for restoring native heart function.
Purpose of the Study:
- To review surgical ventricular restoration (SVR) concepts and techniques for end-stage heart failure.
- To discuss alternative surgical approaches for functional mitral regurgitation.
Main Methods:
- Review of surgical ventricular restoration (SVR) procedures, including the Dor procedure.
- Description of novel techniques: overlapping ventriculoplasty and mitral complex reconstruction.
- Discussion of surgical ventricular restoration (SVR) modifications for non-ischemic dilated cardiomyopathy.
Main Results:
- The Dor procedure effectively excludes scarred septum and reduces ventricular cavity but may cause spherical shape.
- Partial left ventriculectomy is not recommended for non-ischemic dilated cardiomyopathy.
- Overlapping ventriculoplasty and mitral complex reconstruction offer potential alternatives without resecting viable muscle.
Conclusions:
- Novel SVR modifications and mitral reconstruction techniques may serve as alternatives to cardiac transplantation.
- Long-term prognosis of these procedures requires further investigation.
- These surgical options could be vital bridges to cardiac transplantation for end-stage heart failure patients.
Abstract:
Cardiac transplantation, a final option of treatment for refractory heart failure, has not been a standard procedure in Japan especially, mainly because of the shortage of donors. However, surgical methods to restore native heart function, such as surgical ventricular restoration (SVR), are often effective for these cases. The Dor procedure has been used for ischemic cardiomyopathy cases presenting with broad akinetic segments. This is a fine method to exclude the scarred septum and to reduce the intraventricular cavity by encircling purse-string suture, but it may produce a postoperative spherical ventricular shape as a result of endoventricular patch repair. Also, partial left ventriculectomy is not recommended for non-ischemic dilated cardiomyopathy cases for now. A modification of these SVR and surgical approaches to functional mitral regurgitation has been named "overlapping ventriculoplasty" without endoventricular patch and resection of viable cardiac muscle, and "mitral complex reconstruction", which consists of mitral annuloplasty, papillary muscle approximation, and suspension. Although the long-term prognosis of these procedures is undetermined, they could be an important option, at least as an alternative bridge to transplantation. This review will describe the concepts and some technical aspects of these procedures for the end-stage heart.
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