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Surgical ventricular restoration and other surgical approaches to heart failure

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Abstract

Historically, few patients with ischemic congestive heart failure (CHF) have been considered for cardiac surgical intervention unless there was an obvious need for coronary revascularization or valve repair. New surgical procedures and nonmechanical assist devices are being used and tested in patients with end-stage CHF. We report on The Ohio State University Medical Center’s early involvement in the international and multi-institutional Surgical Treatment for Ischemic Heart Failure (STICH) trial, which is evaluating the value of coronary artery bypass in patients with ischemic CHF as compared to medical therapies alone, and whether surgical ventricular restoration (SVR) offers additional benefit to patients with dilated hearts undergoing revascularization. Beyond standard coronary revascularization and SVR, new surgically deployed devices that attempt to augment ventricular performance by direct restraint of left ventricular dilatation or by reducing ventricular wall stress through altering ventricular shape are reviewed. The growing clinical and experimental experience with cellular cardiomyoplasty (in particular, autologous skeletal myoblast and adult-derived stem transplantation) also is reviewed. This review is intended to express the institutional insights of the authors, who have been involved in clinical trials and basic science research in each of these areas.

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References and Recommended Reading

  1. Bolling SF, Pagani FD, Deeb GM, Bach DS: Intermediateterm outcome of mitral reconstruction in cardiomyopathy. J Thorac Cardiovasc Surg 1998, 115:381–388.

    Article  PubMed  CAS  Google Scholar 

  2. National Heart, Lung, and Blood Institute, National Institutes of Health Data Fact Sheet: Congestive heart failure in the United States: a new epidemic. http://www/nhlbi.nih.gov/ health/public/heart/other/chf.htm. Accessed July 8, 2003.

  3. Demivoric J, Rineas R, Rudolph M: Epidemiology of congestive heart failure in three ethnic groups. Congest Heart Fail 2001, 7:93–96.

    Google Scholar 

  4. Cope JT, Kaza AK, Reade CC, et al.: A cost comparison of heart transplantation versus alternative operations for cardiomyopathy. Ann Thorac Surg 2001, 72:1298–1305.

    Article  PubMed  CAS  Google Scholar 

  5. Trachiotis GD, Weintraub WS, Johnston TS, et al.: Coronary artery bypass grafting in patients with advanced left ventricular dysfunction. Ann Thorac Surg 1998, 66:1632–1639.

    Article  PubMed  CAS  Google Scholar 

  6. Bodi V, Sanchis J, Berenguer A, et al.: Wall motion of noninfarcted myocardium: relationship to regional and global systolic function and to early and late left ventricular dilatation. Int J Cardiol 1999, 71:157–165.

    Article  PubMed  CAS  Google Scholar 

  7. Mitchell GF, Lamas GA, Vaughan DE, Pfeffer MA: Left ventricular remodeling in the year after first anterior myocardial infarction: a quantitative analysis of contractile segment lengths and ventricular shape. J Am Coll Cardiol 1992, 19:1136–1144. This meticulous study of approximately 50 patients 3 weeks and 1 year after myocardial infarction shows that ventricular dilatation was the result of remote myocardial contractile segment lengthening and not the result of progressive infarct expansion.

    Article  PubMed  CAS  Google Scholar 

  8. Paulus WJ: How are cytokines activated in heart failure? Eur J Heart Fail 1999, 1:309–312.

    Article  PubMed  CAS  Google Scholar 

  9. Baumgarten G, Knuefermann P, Kalra D, et al.: Load-dependent and independent regulation of proinflammatory cytokine and cytokine receptor gene expression in the adult mammalian heart. Circulation 2002, 105:2192–2197.

    Article  PubMed  CAS  Google Scholar 

  10. Crilley JG, Farrer M: Left ventricular remodeling and brain natriuretic peptide after first myocardial infarction. Heart 2001, 86:638–642.

    Article  PubMed  CAS  Google Scholar 

  11. Richards AM, Nichols MG, Yandle TG, et al.: Neuroendocrine prediction of left ventricular function and heart failure after acute myocardial infarction. Heart 1999, 81:114–201.

    PubMed  CAS  Google Scholar 

  12. Serneri GG, Modesti PA, Boddi M, et al.: Cardiac growth factors in human hypertrophy: relations with myocardial contractility and wall stress. Circ Res 1999, 85:57–67.

    PubMed  CAS  Google Scholar 

  13. Pfeffer MA, Braunwald E: Ventricular remodeling after myocardial infarction: experimental observations and clinical implications. Circulation 1990, 81:1161–1172.

    PubMed  CAS  Google Scholar 

  14. Altman L: Brazil surgeon develops a bold, promising operation for patients with heart failure. New York Times. June 14, 1996; sect A:16.

  15. Cooley D: Ventricular endoaneurysmorrhaphy: a simplified repair for extensive post-infarction aneurysm. J Card Surg 1989, 4:200–205.

    PubMed  CAS  Google Scholar 

  16. Jatene AD: Left ventricular aneurysmectomy: resection or reconstruction. J Thorac Cardiovasc Surg 1985, 89:321–331.

    PubMed  CAS  Google Scholar 

  17. Dor V, Di Donato M, Toso A, et al.: Intermediate survival and predictors of death after surgical ventricular restoration. Semin Thorac Cardiovasc Surg 2001, 13:468–475.

    PubMed  Google Scholar 

  18. Buckberg G: Defining the relationship between akinesia and dyskinesia and the cause of left ventricular failure after anterior infarction and reversal of remodeling to restoration. J Thorac Cardiovasc Surg 1998, 116:47–49.

    Article  PubMed  CAS  Google Scholar 

  19. Di Donato M, Sabatier M, Dor V, et al.: Akinetic versus dyskinetic postinfarction scar: relation to surgical outcome in patients undergoing endoventricular circular patch plasty repair. J Am Coll Cardiol 1997, 29:1569–1575. This is a retrospective study demonstrating that patients with classic anteroseptal dyskinetic aneurysms and patients with areas of akinesis benefited from the Dor procedure (SVR).

    Article  PubMed  Google Scholar 

  20. Dor V, Sabatier M, Di Donato M, et al.: Efficacy of endoventricular patch plasty in large postinfarction akinetic scar and severe left ventricular dysfunction: comparison with a series of large dyskinetic scars. J Thorac Cardiovasc Surg 1998, 116:50–59.

    Article  PubMed  CAS  Google Scholar 

  21. Menicanti L, Di Donato M: The Dor preocedure: what has changed after fifteen years of clinical practice? J Thorac Cardiovasc Surg 2002, 124:886–890. This article reviews current concepts of SVR and reports on the Milan experience in 985 patients.

    Article  PubMed  Google Scholar 

  22. Di Donato M, Sabatier M, Toso A, et al.: Regional myocardial performance of non-ischemic zones remote from anterior wall left ventricular aneurysm: effects of aneurysmectomy. Eur Heart J 1995, 16:1285–1292.

    Google Scholar 

  23. Athanasuleas CL, Stanley AW, Buckberg GD, et al.: Surgical anterior ventricular endocardial restoration for dilated ischemic cardiomyopathy. Semin Thorac Cardiovasc Surg 2001, 13:448–457.

    PubMed  CAS  Google Scholar 

  24. Athanasuleas CL, Stanley AW, Buckberg GD et al.: Surgical anterior ventricular endocardial restoration in the dilated remodeled ventricle after anterior myocardial infarction. J Am Coll Cardiol 2001, 37:1199–1209. The authors report on the international RESTORE group’s experience with SVR in 439 patients. It is the most comprehensive and wellcontrolled experience (nonrandomized) with SVR and is the predecessor to the National Heart, Lung, and Blood Institute’s STICH trial.

    Article  PubMed  CAS  Google Scholar 

  25. Chaudhry PA, Mishima T, Sharov VG, et al.: Passive epicardial containment prevents ventricular remodeling in heart failure. Ann Thorac Surg 2000, 70:1275–1280.

    Article  PubMed  CAS  Google Scholar 

  26. Kass DA, Baughman KL, Pak PH, et al.: Reverse remodeling from cardiomyoplasty in human heart failure: external constraint versus active assist. Circulation 1995, 91:2314–2318.

    PubMed  CAS  Google Scholar 

  27. Saavedra WF, Tunin RS, Paolocci N, et al.: Reverse remodeling and enhanced adrenergic reserve from passive external support in experimental dilated heart failure. J Am Coll Cardiol 2002, 39:2069–2076.

    Article  PubMed  CAS  Google Scholar 

  28. Raman JS, Hata M, Storer M, et al.: The mid-term results of ventricular containment for end-stage ischemic cardiomyopathy. Ann Thorac Cardiovasc Surg 2001, 7:278–281.

    PubMed  CAS  Google Scholar 

  29. McCarthy PM, Takagaki M, Ochiai Y, et al.: Device-based change in left ventricular shape: a new concept for the treatment of dilated cardiomyopathy. J Thorac Cardiovasc Surg 2001, 122:482–490.

    Article  PubMed  CAS  Google Scholar 

  30. Schenk S, Reichenspurner H, Boehm DH, et al.: Myosplint implant and shape change procedure: intra- and perioperative safety and feasibility. J Heart Lung Transplant 2002, 21:680–686.

    Article  PubMed  Google Scholar 

  31. Hunt AH, Baker DW, Chin MH, et al.: ACC/AHA guidelines for evaluation and management of chronic heart failure in the adult: executive summary. Circulation 2001, 104:2996–3007.

    PubMed  CAS  Google Scholar 

  32. Hertz MI, Taylor DO, Trulock EP, et al.: The registry of the international society of heart and lung transplantation: nineteenth official report-2002. J Heart Lung Transplant 2002, 21:950–970.

    Article  PubMed  Google Scholar 

  33. Chiu RC, Zibaitis A, Koa RL: Cellular cardiomyoplasty: myocardial regeneration with satellite cell implantation. Ann Thorac Surg 1995, 60:12–18.

    PubMed  CAS  Google Scholar 

  34. Reinlib L, Field L: Cell transplantation as future therapy for cardiovascular disease? Circulation 2000, 101:e182-e187.

    PubMed  CAS  Google Scholar 

  35. Mauro A: Satellite cell of skeletal muscle fibers. J Biophys Biochem Cytol 1961, 9:493–495.

    Article  PubMed  CAS  Google Scholar 

  36. Atkins BZ, Hueman MT, Meuchel J, et al.: Cellular cardiomyoplasty improves diastolic properties of the injured heart. J Surg Res 1999, 85:234–242.

    Article  PubMed  CAS  Google Scholar 

  37. Jain M, Der Simonian H, Brenner DA, et al.: Cell therapy attenuates deleterious ventricular remodeling and improves cardiac performance after myocardial infarction. Circulation 2001, 103:1920–1927.

    PubMed  CAS  Google Scholar 

  38. Hutcheson KA, Atkins BZ, Hueman MT, et al.: Comparison of benefits on myocardial performance of cellular cardiomyoplasty with skeletal myoblasts and fibroblasts. Cell Transplant 2000, 9:359–368.

    PubMed  CAS  Google Scholar 

  39. Pagani FD, DerSimonian H, Zawadzka A, et al.: Autologous skeletal myoblasts transplanted to ischemia-damaged myocardium in humans. J Am Coll Cardiol 2003, 41:879–888. This is the first report of autologous skeletal myoblasts surviving in patients in areas of myocardial scar. Autologous skeletal myoblasts were injected at the time of LVAD implantation and histology was obtained at the time of explant.

    Article  PubMed  Google Scholar 

  40. Reinecke H, MacDonald GH, Hauschka SD, Murry CE: Electromechanical coupling between skeletal and cardiac muscle: implication for infarct repair. J Cell Biol 2000, 149:731–740.

    Article  PubMed  CAS  Google Scholar 

  41. Li RK, Jia ZQ, Weisel RD, et al.: Cardiomyocyte transplantation improves heart function. Ann Thorac Surg 1996, 62:654–661.

    Article  PubMed  CAS  Google Scholar 

  42. Scorsin M, Hagege A, Vilquin JT, et al.: Comparison of effects of fetal cadiomyocyte and skeletal myoblast transplantation on postinfarction left ventricular function. J Thorac Cardiovasc Surg 2000, 119:1169–1175.

    Article  PubMed  CAS  Google Scholar 

  43. Taylor DA, Atkins BZ, Hungspreugs P, et al.: Regenerating functional myocardium: improved performance after skeletal myoblast transplantation. Nat Med 1998, 4:929–933.

    Article  PubMed  CAS  Google Scholar 

  44. Ghostine S, Carrion C, Souza LCG, et al.: Long-term efficacy of myoblast transplantation on regional structure and function after myocardial infarction. Circulation 2002, 106(Suppl I):I131-I136. This study demonstrates functional and geometric improvements in sheep with experimental myocardial infarctions transplanted with autologous skeletal myoblasts using strain Doppler echocardiography.

    PubMed  Google Scholar 

  45. Menasche P, Hagege AA, Scorsin M, et al.: Myoblast transplantation for heart failure. Lancet 2001, 357:279–280. This is the first report of autologous skeletal myoblast transplantation in a patient with end-stage CHF who is undergoing concomitant coronary artery bypass.

    Article  PubMed  CAS  Google Scholar 

  46. Menasche P, Hagege AA, Vilquin JT, et al.: Autologous skeletal myoblast transplantation for severe postinfarction left ventricular dysfunction. J Am Coll Cardiol 2003, 41:1078–1083.

    Article  PubMed  Google Scholar 

  47. Dib N, McCarthy P, Campbell A, et al.: Safety and feasibility of autologous myoblast transplantation in patients undergoing coronary artery bypass grafting: results from the United States experience. Circulation 2002, 106(Suppl II):463.

    Google Scholar 

  48. Tomita S, Li RK, Weisel RD, et al.: Autologous transplantation of bone marrow cells improves damaged heart function. Circulation 1999, 100(Suppl II):247–256.

    Google Scholar 

  49. Shake JG, Gruber PJ, Baumbartner WA, et al.: Mesenchymal stem cell implantation in a swine myocardial infarct model: engraftment and functional effects. Ann Thorac Surg 2002, 73:1919–1926.

    Article  PubMed  Google Scholar 

  50. Associated Press: Stem cells transplanted to teen’s heart: experimental procedure aims to grow new muscle, vessels. http://www.cnn.com/2003/HEALTH/conditions/03/06/ teen.heart.ap/. Accessed March 6, 2003.

  51. Strauer BE, Brehm M, Zeus T, et al.: Repair of infarcted myocardium by autologous intracoronary mononuclear bone marrow cell transplantation in humans. Circulation 2002, 106:1913–1918.

    Article  PubMed  Google Scholar 

  52. Fuchs S, Satler LF, Kornowski R, et al.: Catheter-based autologous bone marrow myocardial injection in nooption patients with advanced coronary artery disease: a feasibility study. J Am Coll Cardiol 2003, 41:1721–1724.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiothoracic Surgery, N847 Doan Hall, 410 W. 10th Avenue, 43210, Columbus, OH, USA

    Robert E. Michler MD

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  1. Patrick I. McConnell MD
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  2. Robert E. Michler MD
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McConnell, P.I., Michler, R.E. Surgical ventricular restoration and other surgical approaches to heart failure. Curr Heart Fail Rep 1, 21–29 (2004). https://doi.org/10.1007/s11897-004-0013-8

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  • DOI: https://doi.org/10.1007/s11897-004-0013-8

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