Abstract
Heart transplantation remains the gold standard treatment for “end-stage” dilated cardiomyopathy. However, its epidemiologic impact on the heart failure problem continues to be small due to limited donor organ availability and contraindications. Therefore, several “conventional” surgical procedures have been developed to reverse the vicious cycle of ventricular remodeling that accompanies systolic heart failure and to improve symptoms and survival of the patients. This review discusses indications, results, and limitations of the most common surgical methods currently used to arrest or reverse cardiac remodeling.
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References and Recommended Reading
Pieske B: Reverse remodeling in heart failure — fact or fiction? Eur Heart J 2004, 6(Suppl D):55–78.
Pfeffer MA, Braunwald E, Moye LA, et al.: Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. N Engl J Med 1992, 327:669–677.
Cohn JN: Structural basis for heart failure. Circulation 1995, 91:2504–2507.
Lytle BW: The role of coronary revascularization in the treatment of ischemic cardiomyopathy. Ann Thorac Surg 2003, 75(6 Suppl):S2–S5.
McGee EC, Grady KL, McCarthy PM: Nontransplant surgical alternatives for heart failure. Curr Treat Options Cardiovasc Med 2005, 7:491–501.
McCarthy PM: New surgical options for the failing heart. J Heart Valve Dis 1999, 8:472–475.
Bax JJ, Visser FC, Poldermans D, et al.: Time course of functional recovery of stunned and hibernating segments after surgical revascularization. Circulation 2001, 104(Suppl 1):1314–1318.
Samady H, Elefteriades JA, Abbott BG, et al.: Failure to improve left ventricular function after coronary revascularization for ischemic cardiomyopathy is not associated with worse outcome. Circulation 1999, 100:1298–1304.
Alfieri O, La Canna G., Giubbini R, et al.: Recovery of myocardial function: the ultimate target of coronary revascularization. Eur J Cardiothorac Surg 1993, 7:325–330.
Bax JJ, Poldermans D, Elhendy A, et al.: Improvement of left ventricular ejection fraction, heart failure symptoms and prognosis after revascularization in patients with chronic coronary artery disease and viable myocardium detected by dobutamine stress echocardiography. J Am Coll Cardiol 1999, 34:163–169.
Di Carli MF, Asgarzadie F, Schelbert HR, et al.: Quantitative relation between myocardial viability and improvement in heart failure symptoms after revascularization in patients with ischemic cardiomyopathy. Circulation 1995, 92:3436–3444.
Allman KC, Shaw LJ, Hachamovitch R, et al.: Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis. J Am Coll Cardiol 2002, 39:1151–1158.
Bourque JM, Hasselblad V, Velazquez EJ, et al.: Revascularization in patients with coronary artery disease, left ventricular dysfunction and viability: a meta-analysis. Am Heart J 2003, 146:621–627.
Tarakji KG, Brunken R, McCarthy PM, et al.: Myocardial viability testing and the effect of early intervention in patients with advanced left ventricular systolic dysfunction. Circulation 2006, 113:230–237.
Dispersyn GD, Borgers M, Flameng W: Apoptosis in chronic hibernating myocardium: sleeping to death? Cardiovasc Res 2000, 45:696–703.
Rahimtoola SH, La Canna G, Ferrari R, et al.: Hibernating myocardium: another piece of the puzzle falls into place. J Am Coll Cardiol 2006, 47:978–980.
Rizzello V, Poldermans D, Boersma E, et al.: Opposite patterns of left ventricular remodeling after coronary revascularization in patients with ischemic cardiomyopathy. Role of myocardial viability. Circulation 2004, 110:2383–2388.
Mule JD, Bax JJ, Zingone B, et al.: The beneficial effect of revascularization on jeopardized myocardium: reverse remodeling and improved long-term prognosis. Eur J Cardiothorac Surg 2002, 22:426–430.
Bax JJ, Schinkel AF, Boersma E, et al.: Extensive left ventricular remodeling does not allow viable myocardium to improve in left ventricular ejection fraction after revascularization and is associated with worse long-term prognosis. Circulation 2004, 110(11 Suppl 1):I118–I122.
Yamaguchi A, Ino T, Adachi H, et al.: Left ventricular volume predicts postoperative course in patients with ischemic cardiomyopathy. Ann Thorac Surg 1998, 65:434–438.
Dor V: The endoventricular circular patch plasty (“Dor procedure”) in ischemic akinetic dilated ventricles. Heart Fail Rev 2001, 6:187–193.
Schenk S, McCarthy PM, Starling RC, et al.: Neurohormonal response to left ventricular reconstruction surgery in ischemic cardiomyopathy. J Thorac Cardiovasc Surg 2004, 128:38–43.
Dor V: Left ventricular reconstruction: the aim and the reality after twenty years. J Thorac Cardiovasc Surg 2004, 128:17–20.
Artrip JH, Oz MC, Burkoff D: Left ventricular volume reduction surgery for heart failure: a physiologic perspective. J Thorac Cardiovasc Surg 2001, 122:775–782.
Athanasuleas CL, Buckberg GD, Stanley AW, et al.: Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation. J Am Coll Cardiol 2004, 44:1439–1445.
Castiglioni A, Quarti A, Schreuder J, et al.: Surgical restoration of the left ventricle for postinfarction aneurysm. Ital Heart J 2002, 3:370–374.
Franco-Cereceda A, McCarthy PM, Blackstone EH, et al.: Partial left ventriculectomy for dilated cardiomyopathy: is this an alternative to transplantation? J Thorac Cardiovasc Surg 2001, 121:879–893.
Suma H, Horii T, Isomura T, Buckberg GD: A new concept for ventricular restoration for nonischemic dilated cardiomyopathy. Eur J Cardiothorac Surg 2006, 29S:S207–S212.
Suma H; RESTORE Group: Left ventriculoplasty for nonischemic dilated cardiomyopathy. Semin Thorac Cardiovasc Surg 2001, 13:514–521.
Bolling SF, Smolens IA, Pagani FD: Surgical alternatives for heart failure. J Heart Lung Transplant 2001, 20:729–733.
Bax JJ, Braun J, Somer ST, et al.: Restrictive annuloplasty and coronary revascularization in ischemic mitral regurgitation results in reverse left ventricular remodeling. Circulation 2004, 110(11 Suppl 1):II103–II108.
Wu AH, Aaronson KD, Bolling SF, et al.: Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction. J Am Coll Cardiol 2005, 45:381–387.
McGee EC, Gillinov AM, Blackstone EH, et al.: Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation. J Thorac Cardiovasc Surg 2004, 128:916–924.
Spoor MT, Geltz A, Bolling SF: Flexible versus nonflexible mitral valve rings for congestive heart failure: differential durability of repair. Circulation 2006, 114(1 Suppl):I67–I71.
De Bonis M, Lapenna E, La Canna G, et al.: Mitral valve repair for functional mitral regurgitation in end-stage dilated cardiomyopathy. Role of the “edge-to-edge” technique. Circulation 2005, 112(9 Suppl):I402–I408.
Borger MA, Murphy PM, Alam A, et al.: Initial results of the chordal-cutting operation for ischemic mitral regurgitation. J Thorac Cardiovasc Surg 2007, 133:1483–1492.
Hung J, Papakostas L, Tahta SA, et al.: Mechanism of recurrent ischemic mitral regurgitation after annuloplasty. Continued LV remodeling as a moving target. Circulation 2004, 110(11 Suppl 1):I185–I190.
De Bonis M, Lapenna E, Verzini A, et al.: Recurrence of MR parallels the absence of left LV reverse remodeling after mitral repair in advanced DCM [abstract]. Presented at 5th EACTS/ESTS Joint Meeting. Stockholm, Sweden; September 12, 2006.
Acker MA: Clinical results with the Acorn cardiac restraint device with and without mitral valve surgery. Semin Thorac Cardiovasc Surg 2005, 17:361–363.
Grossi EA, Saunders PC, Woo YJ, et al.: Intraoperative effects of the coapsys annuloplasty system in a randomized evaluation (RESTOR-MV) of functional ischemic mitral regurgitation. Ann Thorac Surg 2005, 80:1706–1711.
Stulak JM, Dearani JA, Daly RC, et al.: Left ventricular dysfunction in atrial fibrillation: restoration of sinus rhythm by the Cox-maze procedure significantly improves systolic function and functional status. Ann Thorac Surg 2006, 82:494–500.
Hetzer R, Muller JH, Weng Y, et al.: Bridging-to-recovery. Ann Thorac Surg 2001, 71(3 Suppl):S109–S113.
Frazier OH, Delgado RM 3rd, Scroggins N, et al.: Mechanical bridging to improvement in severe acute “nonischemic, nonmyocarditis” heart failure. Congest Heart Fail 2004, 10:109–113.
Mancini DM, Beniaminovitz A, Levin H, et al.: Low incidence of myocardial recovery after left ventricular assist device implantation in patients with chronic heart failure. Circulation 1998, 98:2383–2389.
Dandel M, Weng Y, Siniawski H, et al.: Long-term results in patients with idiopathic dilated cardiomyopathy after weaning from left ventricular assist devices. Circulation 2005, 112(9 Suppl):137–145.
Simon MA, Kormos RL, Murali S, et al.: Myocardial recovery using ventricular assist devices: prevalence, clinical characteristics, and outcomes. Circulation 2005, 112(9 Suppl):132–136.
Maybaum S, Mancini D, Xydas S, et al.: Cardiac improvement during mechanical circulatory support: a prospective multicenter study of the LVAD Working Group. Circulation 2007, 115:2497–2505.
Birks EJ, Tansley PD, Hardy J, et al.: Left ventricular assist device and drug therapy for reversal of heart failure. N Engl J Med 2006, 355:1873–1884.
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De Bonis, M., Alfieri, O. Surgical methods to reverse left ventricular remodeling. Curr Heart Fail Rep 4, 214–220 (2007). https://doi.org/10.1007/s11897-007-0015-4
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DOI: https://doi.org/10.1007/s11897-007-0015-4