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Heart Failure Reviews

, Volume 9, Issue 4, pp 329–336 | Cite as

Role of Site Selection for Left Ventriculoplasty to Treat Idiopathic Dilated Cardiomyopathy

  • Hisayoshi Suma
  • Tadashi Isomura
  • Taiko Horii
  • Gerald Buckberg
  • The RESTORE Group
Article

Abstract

Ventriculoplasty was introduced to treat patients with chronic progressive heart failure from end-stage non ischemic dilated cardiomyopathy, which was presumed to be a homogeneous disease. However ventriculoplasty is not commonly used today, because variable results follow using only lateral ventriculoplasty as the treatment tool. This report traces our evolution in surgical management, defines that the homogeneous disease concept is not correct, and centers upon the importance of site selection, appropriate timing, and methods of patient selection.

Left ventriculoplasty by either partial left ventriculoplasty (PLV) or septal anterior ventricular exclusion (SAVE or Pacopexy) was performed in 96 high risk (44% NYHA Class III, and 56% Class IV) patients with idiopathic dilated cardiomyopathy over the past 8 years. Overall hospital mortality was 8% in elective operations and 57% in emergency operations. Hemodynamic and functional improvement was evident from ejection fraction rising from 20% to 31%, and improved NYHA Class 3.6 to 1.8. The global series showed 1, 5 and 7 year survival rate was 66.4, 44.7 and 41.3%, respectively. However surgical results improved as experience allowed development of a strategy for timing, and defining proper exclusion site selection. Non homogeneous ventricular disease was identified, and 69% 4 year survival resulted from our intraoperative definition of the most diseased segment (septum or lateral wall), and then exclusion of this site.

This evolving experience indicates that left ventriculoplasty is effective treatment for patients with end-stage cardiomyopathy, provided proper patient selection, appropriate timing of the operation, and choice of procedure are used as keys to a successful outcome.

Keywords

Non ischemic cardiomyopathy site selection SAVE Pacopexy echo testing congestive heart failure LV culprit muscle 

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Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Hisayoshi Suma
    • 1
  • Tadashi Isomura
    • 1
  • Taiko Horii
    • 1
  • Gerald Buckberg
    • 1
    • 2
    • 3
  • The RESTORE Group
  1. 1.Hayama Heart CenterKanagawaJapan
  2. 2.David Geffen School of Medicine at UCLALos AngelesUSA
  3. 3.David Geffen School of Medicine at UCLALos AngelesUSA

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