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Published on: July 18, 2014
Surgical ventricular reconstruction for ischaemic heart failure: state of the art
Serenella Castelvecchio1, Andrea Garatti1, Pier Vincenzo Gagliardotto1
1Department Cardiac Surgery, I.R.C.C.S., Policlinico San Donato, Milan, Italy.
Insights
Surgical ventricular reconstruction (SVR) can improve cardiac function in patients with ischemic heart failure and left ventricular dysfunction. This review discusses SVR
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Failure Research
Background:
- Ischemic cardiomyopathy with left ventricular (LV) systolic dysfunction poses the highest risk for heart failure (HF).
- Guideline-driven medical therapy improves survival and quality of life but may not fully address LV remodeling.
- Surgical interventions like coronary artery bypass grafting, surgical ventricular reconstruction (SVR), and mitral valve surgery are considered for advanced cases.
Purpose of the Study:
- To review the rationale, techniques, and indications for Surgical Ventricular Reconstruction (SVR) in treating ischemic heart failure.
- To present insights from a center with extensive global experience in SVR.
- To discuss evolving data on the efficacy of SVR for ischemic heart failure.
Main Methods:
- Literature review focusing on SVR for ischemic heart failure.
- Analysis of surgical techniques and patient selection criteria.
- Discussion of clinical outcomes and evolving evidence.
Main Results:
- SVR aims to reduce LV volumes by excluding scar tissue, restoring normal shape and function.
- The procedure can improve cardiac function and clinical status in selected patients.
- Evidence is evolving regarding the long-term role and optimal application of SVR.
Conclusions:
- SVR is a therapeutic option for specific patients with ischemic heart failure and LV dysfunction.
- Careful patient selection and surgical technique are crucial for successful outcomes.
- Further research and data analysis are needed to refine the role of SVR in managing ischemic heart failure.
Abstract:
Patients with ischaemic cardiomyopathy and left ventricular (LV) systolic dysfunction represent the highest-risk population with heart failure (HF). The cornerstone of treatment remains guideline-driven medical therapy, which is associated with significant improvement in survival and quality of life. The most commonly considered surgical interventions are coronary artery bypass graft surgery, at times combined with surgical ventricular reconstruction (SVR) and surgery for mitral valve regurgitation. Surgical ventricular reconstruction has been introduced as an optional therapeutic strategy aimed to reduce LV volumes through the exclusion of the scar tissue, thereby restoring the physiological volume and shape and improving cardiac function and clinical status. This review will briefly discuss the rationale to surgically reverse LV remodelling, the technique, and the indications, to the best of our knowledge, coming from the Center with the largest worldwide experience. The evolving data on the role of SVR for the treatment of ischaemic HF will be addressed as well.
