Surgical left ventricular reconstruction

Because of the shortage of donors for heart transplantation, surgical ventricular reconstruction (SVR) has been under development to treat end-stage heart failure due to a dilated left ventricle. The operative procedures have been developed and modified based on the clinical results and preoperative findings of several examinations. SVR is performed to reduce the size and volume of the ventricle as well as to reshape it. The procedures, which differ based on the particular left ventricular lesion, are endoventricular patch plasty or septal anterior ventricular restoration for anteroseptal exclusion and partial left ventriculectomy or a posterior restoration procedure for posterolateral exclusion. In the indicated patients, SVR has been emerging as an alternative to heart transplantation. The accumulating surgical knowledge may provide new opportunities for the treatment of ischemic dilated cardiomyopathy. The Surgical Treatment for Ischemic Heart Failure (STICH) trial seems to have arrived at a misguided conclusion. Surgeons have to know not only the operative procedures for SVR; they must also be aware of the systolic and diastolic functioning and the volume and size of the left ventricle before and after SVR. Hence, SVR is reviewed and discussed here.