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Surgery for heart failure

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Conclusions

As heart failure may appear in myriad forms and different stages in different patients, there is no single surgical solution. Surgical treatment may have electrical, mechanical or biologic or a combined approach to the problem of CHF. In the management of heart failure, surgical therapy is most effective when applied in its proper window. It may be possible to restore anatomic and physiologic normalcy in some patients while partial recovery by arrest of remodelling process may be all that can be achieved in some. A holistic philosophy entailing both medical and surgical modalities would be needed to contain the scourage of CHF.

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References

  1. Kannel W, Sutton GS Epidemiology of heart failure. In: Poole Wilson P.A., ed. Heart failure. London: Churchill Livingstone, 1997: 279–87.

    Google Scholar 

  2. Buckberg GD. Congestive heart failure: Treat the disease, not the symptom—Return to normalcy. J Thorac Cardiovasc Surg 2001; 121: 628–37.

    Article  CAS  PubMed  Google Scholar 

  3. Lee TH, Hamilton MA, Stevenson LW, et al. Impact of left ventricular cavity size on survival in advanced heart failure. Am J Cardiol 1993; 72: 672–76.

    Article  CAS  PubMed  Google Scholar 

  4. Douglas PS, Morrow R, Ioli A, Reichek N. Left ventricular shape, afterload and survival in idiopathic dilated cardiomyopathy. J Am Coll Cardiol 1989; 13: 3111–15.

    Google Scholar 

  5. Burch GE, Tsui CY, Harb JM. Ischemic cardiomyopathy. Am Heart J 1972; 83: 340–50.

    Article  CAS  PubMed  Google Scholar 

  6. Gaudron P, Eilles C, Kugler I, Ertl G. Progressive left ventricular dysfunction and remodeling after myocardial infarction. Potential mechanisms and early predictors. Circulation 1993; 87: 755–63.

    Article  CAS  PubMed  Google Scholar 

  7. Maisch B. Ventricular remodelling. Cardiology 1996; 87(suppl 1): 2–10.

    Article  PubMed  Google Scholar 

  8. Grossman W, Jones D, McLaurin LP. Wall stress and pattern of hypertrophy in the human left ventricle. J Clin Invest 1975; 56: 56–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Suma H, Isomura T, Horii T, Hisatomi K. Left ventriculoplasty for ischemic cardiomyopathy Eur J Cardiothorac Surg 2001; 20: 319–23.

    Article  CAS  PubMed  Google Scholar 

  10. Yatteau RF, Peter RH, Behar VS, Bartle AG, Rosati RA, Kong Y. Ischemic cardiomyopathy; the myopathy of coronary artery disease. Am J Cardiol 1974; 34: 520–25.

    Article  CAS  PubMed  Google Scholar 

  11. Faulkner SL, Stoney WS, Alford WC, Thomas CS, Burrus GR, Frist RA, Page HL. Ischemic cardiomyopathy; medical versus surgical treatment. J Thorac Cardiovasc Surg 1977; 74: 77–88.

    CAS  PubMed  Google Scholar 

  12. Manley JC, King JF, Zeft HJ, Johnson WD. The ‘Bad’ ventricle: results of coronary surgery and effect on late survival. J Thorac Cardiovasc Surg 1976; 72: 841–48.

    CAS  PubMed  Google Scholar 

  13. Dreyfus GD, Duboc D, Blasco A, et al. Myocardial viability assessment in ischemic cardiomyopathy: benefits of coronary revascularization. Ann Thorac Surg 1994; 57: 1402–07.

    Article  CAS  PubMed  Google Scholar 

  14. White HD, Norris RM, Brown MA, Brandt PWT, Whitlock RML, Wild CJ. Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation 1987; 76: 44–51.

    Article  CAS  PubMed  Google Scholar 

  15. Yamaguchi A, Ino T, Adachi H, Murata S, Kamio H, Okada M, Tsuboi J. Left ventricular volume predicts postoperative course in patients with ischemic cardiomyopathy. Ann Thorac Surg 1998; 65: 434–48.

    Article  CAS  PubMed  Google Scholar 

  16. Luciani GB, Montalbano G, Casali G, Mazzucco A. Predicting long-term functional results after myocardial revascularization in ischemic cardiomyopathy. J Thorac Cardiovasc Surg 2000; 120: 478–89.

    Article  CAS  PubMed  Google Scholar 

  17. Elefteriades JA, Morales DLS, Gradel C, Tollis G, Levi E, Zaret BL. Results of coronary artery bypass grafting by a single surgeon in patients with left ventricular ejection fraction less than 30%. Am J Cardiol 1997; 79: 1573–78.

    Article  CAS  PubMed  Google Scholar 

  18. Christakis GT, Weisel RD, Fremes SE, Ivanov J, David TE, Goldman BS, Salerno TA. Coronary artery bypass grafting in patients with poor ventricular function. J Thorac Cardiovasc Surg 1992; 103: 1083–91.

    CAS  PubMed  Google Scholar 

  19. Milano CA, White WD, Smith LR, Jones RH, Lowe JE, Smith PK, Van Trigt III P. Coronary artery bypass in patients with severely depressed ventricular function. Ann Thorac Surg 1993; 56: 487–93.

    Article  CAS  PubMed  Google Scholar 

  20. Di Carli MF, Maddahi J, Rokhsar S, Schelbert HR, Bianco-Batlles D, Brunken RC, Fromm B. Long-term survival of patients with coronary artery disease and left ventricular dysfunction: implications for the role of myocardial viability assessment in management decisions. J Thorac Cardiovasc Surg 1998; 116: 997–1004.

    Article  PubMed  Google Scholar 

  21. Jones RH. Is it time for a randomized trial of surgical treatment of ischemic heart failure? J Am Coll Cardiol 2001; 37: 1211–13

    Article  Google Scholar 

  22. Minami K. Surgical Treatments for Endstage Heart Failure Due to Dilated Cardiomyopathy Asian Cardiovasc Thorac Ann 2001: 9: 159–66.

    Article  Google Scholar 

  23. Trehan N, Mishra Y, Mehta Y, Jangid DR. Transmyocardial laser as an adjunct to minimally invasive CABG for complete myocardial revascularization. Ann Thorac Surg 1998; 66: 1113–18.

    Article  CAS  PubMed  Google Scholar 

  24. Schofield PM, Sharples LD, Caine N, Burns S, Tait S, Wistow T, Buxton M, Wallwork J. Transmyocardial laser revascularization in patients with refractory angina: a randomized controlled trial. Lancet 1999; 353: 519–24.

    Article  CAS  PubMed  Google Scholar 

  25. Isomura T, Suma H, Horii T, Sato T, Kikuchi N. Partial left ventriculectomy, ventriculoplasty or valvular surgery for idiopathic dilated cardiomyopathy — the role of intra-operative echocardiography. Eur J Cardiothorac Surg 2000; 17: 239–45.

    Article  CAS  PubMed  Google Scholar 

  26. Cazeau S, Ritter P, Bakdach S, et al. Four chamber pacing in dilated cardiomyopathy. Pacing Clin Electrophysiol 1994; 17 (Pt 2): 1974–79.

    Article  CAS  PubMed  Google Scholar 

  27. Bakker P, Meiburg H, de Jonge N, van Mechelen R, Wittkampf F, Mower M. Beneficial effects of biventricular pacing in congestive heart failure (abstract). Pacing Clin Electrophysiol 1994; 17: 820.

    Google Scholar 

  28. Saxon LA, Kumar UN, De Marco T. Heart failure and cardiac resynchronization therapies: US experience in the year 2000. Ann Noninvasive Electrocardiol 2000; 5: 188–94.

    Article  Google Scholar 

  29. Gras D, Mabo P, Tang T, et al. Multisite pacing as a supplemental treatment of congestive heart failure: preliminary results of the Medtronic Inc. Insync study. Pacing Clin Electrophysiol 1998; 21 (Pt 2): 2249–55.

    Article  CAS  PubMed  Google Scholar 

  30. Daubert JC, Ritter P, Le Breton H, et al. Permanent left ventricular pacing with transvenous leads inserted into the coronary veins. Pacing Clin Electrophysiol 1998; 21 (Pt 2): 239–45.

    Article  CAS  PubMed  Google Scholar 

  31. Leclercq F, Hager FX, Macia JC et al. Left ventricular lead insertion using a modified transseptal catheterization technique: a totally endocardial approach for permanent biventricular pacing in end-stage heart failure. Pacing Clin Electrophysiol 1999; 22: 1570–75.

    Article  CAS  PubMed  Google Scholar 

  32. Stevenson LW, Kormos RL. Mechanical cardiac support 2000. Current applications and future trial design. Consensus conference report. J Am Coll Cardiol 2001; 37: 340–70.

    Article  CAS  PubMed  Google Scholar 

  33. Hamdan MH, Zagrodzky JD, Joglar JA, et al. Biventricular pacing decreases sympathetic activity compared with right ventricular pacing in patients with depressed ejection fraction. Circulation 2000; 102: 1027–32.

    Article  CAS  PubMed  Google Scholar 

  34. Minami K, El-Banayosy A, Sezai A, et al. Morbidity and outcome after mechanical ventricular support using Thoratec, Novacor, and HeartMate for bridging to heart transplantation. Artif Organs 2000; 24: 421–26.

    Article  CAS  PubMed  Google Scholar 

  35. Körfer R, El-Banayosy A, Posival H, et al. Mechanical circulatory support: the Bad Oeynhausen experience. Ann Thorac Surg 1995; 59: S56–63.

    Article  PubMed  Google Scholar 

  36. El-Banayosy A, Arusoglu L, Kizner L, et al. Novacor left ventricular assist system versus HeartMate vented electric left ventricular assist system as a long-term mechanical circulatory support device in bridging patients: a prospective study. J Thorac Cardiovasc Surg 2000; 119: 581–87.

    Article  CAS  PubMed  Google Scholar 

  37. Minami K, Arusoglu L, El-Banayosy A, et al. Bridging to heart transplantation using paracorporeal and implantable ventricular assist devices. In: Akutsu T, Koyanagi H, editors. Heart replacement: artificial heart 7. Tokyo: Springer-Verlag 2001. In press.

    Google Scholar 

  38. Mueller J, Wallukat G, Weng YG, et al. Weaning from mechanical cardiac support in patients with idiopathic dilated cardiomyopathy. Circulation 1997; 96: 542–49.

    Article  Google Scholar 

  39. 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: 2383–89.

    Article  CAS  PubMed  Google Scholar 

  40. Wieselthaler GM, Schima H, Hiesmayr M, et al. First clinical experience with the DeBakey VAD continuous axial flow pump for bridge to transplantation. Circulation 2000; 101: 356–59.

    Article  CAS  PubMed  Google Scholar 

  41. Noon GP, Morley D, Benkowski R, DeBakey ME. Clinical experience in 45 patients with MicroMed DeBakey LVAD. 8th Congress of the International Society for Rotary Blood Pumps. Aachen, September 6–9, 2000.

  42. Jarvik R, McConchie S, Jacobs G, Frazier OH, Myers T, Westaby S,. Patient adjusted manual control of the Jarvik 2000 Heart. 8th Congress of the International Society for Rotary Blood Pumps. Aachen, September 6–9, 2000.

  43. Hosenpud JD, Bennett LE, Keck BM, Fiol B, Boucek MM, Novick RJ. The registry of the International Society for Heart and Lung Transplantation: sixteenth official report 1999. J Heart Lung Transplant 1999; 18: 611–26.

    Article  CAS  PubMed  Google Scholar 

  44. Robbins RC, Barlow CW, Oyer PE, Hunt SA, Miller JL, Reitz BA, Stinson EB, Shumway NE. Thirty years of cardiac transplantation at Stanford University. J Thorac Cardiovasc Surg 1999; 117: 939–51.

    Article  CAS  PubMed  Google Scholar 

  45. Stevenson LW, Warner SL, Steimle AE, et al. The impending crisis awaiting cardiac transplantation: modeling a solution based on selection. Circulation 1994; 89: 450–57.

    Article  CAS  PubMed  Google Scholar 

  46. Bolling SF, Deeb M, Brunsting LA, Bach DS. Early outcome of mitral valve reconstruction in patients with end-stage cardiomyopathy. J Thorac Cardiovasc Surg 1995; 109: 676–83.

    Article  CAS  PubMed  Google Scholar 

  47. Bolling SF, Pagani FD, Deeb GM, Bach DS. Intermediate term outcome of mitral reconstruction in cardiomyopathy. J Thorac Cardiovasc Surg 1998; 115: 381–86.

    Article  CAS  PubMed  Google Scholar 

  48. Isomura T, Suma H, Horii T, Sato T, Kikuchi N. Partial left ventriculectomy, ventriculoplasty or valvular surgery for idiopathic dilated cardiomyopathy — the role of intra-operative echocardiography. Eur J Cardiothorac Surg 2000; 17: 239–45.

    Article  CAS  PubMed  Google Scholar 

  49. Carpentier A, Chachques JC. Myocardial substitution with a stimulated skeletal muscle: first successful clinical case. Lancet 1985; 1: 1267.

    Article  CAS  PubMed  Google Scholar 

  50. Bocchi EA, Moreira LF, de Moraes AV, et al. Effects of dynamic cardiomyoplasty on regional wall motion, ejection fraction, and geometry of the left ventricle. Circulation 1992; 86(Suppl II): 231–35.

    Google Scholar 

  51. Schreuder JJ, van der Veen FH, van der Velde ET, et al. Beat to beat analysis of left ventricular pressure-volume relation and stroke volume by conductance catheter and aortic Modelflow in cardiomyoplasty patients. Circulation 1995; 91: 2010–17.

    Article  CAS  PubMed  Google Scholar 

  52. Kass DA, Baughman KL, Pak PH, et al. Reverse remodelling from cardiomyoplasty in human heart failure. External constraint versus active assist. Circulation 1995; 91: 2314–18.

    Article  CAS  PubMed  Google Scholar 

  53. Chachques JC, Berrebi A, Hernigou A, et al. Study of muscular and ventricular function in dynamic cardiomyoplasty: a ten-year follow-up. J Heart Lung Transplant 1997; 16: 854–68.

    CAS  PubMed  Google Scholar 

  54. Braile DM, Godoy MF, Thèvenard GH, Thèvenard RS, Braile MCVB, Leal JCF, Schaldach M. Dynamic cardiomyoplasty: long-term clinical results in patients with dilated cardiomyopathy. Ann Thorac Surg 2000; 69: 1445–47.

    Article  CAS  PubMed  Google Scholar 

  55. Dor V, Kreitmann P, Jourdan J. Interest of ‘physiological’ closure (circumferential plasty on contractile areas) of left ventricle after resection and endocardectomy for aneurysm or akinetic zone: comparison with classical technique about 209 left ventricular resections. J Cardiovasc Surg 1985; 26: 73–79.

    Google Scholar 

  56. Dor V. Left ventricular aneurysm: the endoventricular circular patch plasty. Semin Thorac Cardiovasc Surg 1997; 9: 123–30.

    CAS  PubMed  Google Scholar 

  57. Dor V. Surgical management of left ventricular aneurysms by the endoventricular circular patch plasty technique. Operat Tech Cardiac Thorac Surg 1997; 2: 139–50.

    Article  Google Scholar 

  58. Dor V. Reconstructive left ventricular surgery for postischemic akinetic dilatation. Semin Thorac Cardiovasc Surg 1997; 9: 139–45.

    CAS  PubMed  Google Scholar 

  59. Dor V, Sabatier M, Di Donato M, Montiglio F, Toso A, Maioli M. Efficacy of endoventricular patch plasty repair in large post infarction akinetic scar and severe LV dysfunction. Comparison with a series of large dyskinetic scar. J Thorac Cardiovasc Surg 1998; 116: 50–59.

    Article  CAS  PubMed  Google Scholar 

  60. Fontan F. Transplantation of knowledge. J Thorac Cardiovasc Surg 1990; 99: 387–95

    CAS  PubMed  Google Scholar 

  61. Athanasuleas CL, Stanley AWH, Buckberg GD, Dor V, DiDonato M, Blackstone EH and the RESTORE group. Surgical anterior Ventricular Endocardial Restoration (SAVER) in the dilated remodeled ventricle after anterior myocardial infarction. J Am Coll Cardiol 2001; 37: 1199–1209

    Article  CAS  PubMed  Google Scholar 

  62. Batista RJV, Santos JLV, Takeshita N. Partial left ventriculectomy to improve left ventricular function in end-stage heart disease. J Card Surg 1996; 1: 96–97.

    Article  Google Scholar 

  63. Batista RJ, Verde J, Nery P, et al. Partial left ventriculectomy to treat end-stage disease. Ann Thorac Surg 1997; 64: 634–38

    Article  CAS  PubMed  Google Scholar 

  64. Suma H, Isomura T, Horii T, Sato T, Kikuchi N, Iwahashi K., Hosokawa J. Two-year experience of the Batista operation for non-ischemic cardiomyopathy. J Cardiol 1998; 32: 269–76.

    CAS  PubMed  Google Scholar 

  65. McCarthy PM, Starling RC, Wong J, et al. Early results with partial left ventriculectomy. J Thorac Cardiovasc Surg 1997; 114: 755–63.

    Article  CAS  PubMed  Google Scholar 

  66. Izzat MB, Yim APC, Wan S, Atassi W. A survey on partial left ventriculectomy in the Asia-Pacific region. Ann Thorac Surg 1999; 67: 387–91.

    Article  CAS  PubMed  Google Scholar 

  67. Moreia LFP, Stolf NAG, Bocchi EA, Bacal F, Giorgi MCP, Parga JR., Jatene AD. Partial left ventriculectomy with mitral valve preservation in the treatment of patients with dilated cardiomyopathy. J Thorac Cardiovasc Surg 1998; 115: 800–07.

    Article  Google Scholar 

  68. Gradinac S, Miric M, Popovic Z. Partial left ventriculectomy for idiopathic dilated cardiomyopathy: early results and six-month follow-up. Ann Thorac Surg 1998; 66: 1963–68.

    Article  CAS  PubMed  Google Scholar 

  69. McCarthy JF, McCarthy PM, Starling RC, et al. Partial left ventriculectomy and mitral valve repair for end-stage congestive heart failure. Eur J Cardio-thorac Surg 1998; 13: 337–43.

    Article  CAS  Google Scholar 

  70. Bocchi EA, Bellotti G, Vilella de Moraes A, et al. Clinical outcome after left ventricular surgical remodelling in patients with idiopathic dilated cardiomyopathy referred for heart transplantation. Short-term results. Circulation 1997; 96(Suppl II): 165–72.

    Google Scholar 

  71. Carpentier A. Does surgical reduction of heart size reduce heart failure?. Lancet 1997; 350: 456.

    Article  CAS  PubMed  Google Scholar 

  72. Isomura T, Suma H, Horii T, et al. Left ventricle restoration in patients with non-ischemic dilated cardiomyopathy: risk factors and predictors of outcome and change of mid-term ventricular function Eur J Cardiothorac Surg 2001; 19: 684–89.

    Article  CAS  PubMed  Google Scholar 

  73. Suma H, Beyersdorf F, De Olivera S, et al. Pacopexy — new restoration procedure for non-ischemic dilated cardiomyopathy. J Thorac Cardiovasc Surg 2001: in press.

  74. Buckberg GD, Coghlan HC, Torrent-Guasp F. The structure and function of the helical heart and its buttress wrapping. Geometric concepts of heart failure and use for structural correction. Semin Thorac Cardiovasc Surg 2001; 13: 386–401.

    Article  CAS  PubMed  Google Scholar 

  75. Kaas DA. Surgical approaches to arresting or reversing chronic remodelling of the failing heart. J Card Fail 1998; 4: 57–66.

    Article  Google Scholar 

  76. Kay JH, Dunne E, Krohn BG, et al. Left ventricular excision, exclusion or plication for akinetic areas of the heart. J Thorac Cardiovasc Surg 1970; 59: 139–46.

    CAS  PubMed  Google Scholar 

  77. Savage EB, Downing SW, Ratcliffe MB, et al. Repair of left ventricular aneurysm. Changes in ventricular mechanics, hemodynamics, and oxygen consumption. J Thorac Cardiovasc Surg 1992; 104: 752–62.

    CAS  PubMed  Google Scholar 

  78. Schwarz ER, Speakman MT, Kloner RA. A novel technique of plication without resection for treating infarct expansion and remodeling (abstract). Circulation 1998; 98: Suppl 1: 1–418.

    Google Scholar 

  79. Kresh JY, Wechsler AS. Heart reduction surgery can reconstitute the residual stress-strain state of the left ventricle. J Thorac Cardiovasc Surg 1998; 116: 1084–86.

    Article  CAS  PubMed  Google Scholar 

  80. Hutchins GM, Brawley RK. The influence of cardiac geometry on the results of ventricular aneurysm repair. Am J Pathol 1980; 99: 221–30.

    CAS  PubMed  PubMed Central  Google Scholar 

  81. Ratcliffe MB, Wallace AW, Salahieh A, Hong J, Ruch S, Hall TS. Ventricular volume, chamber stiffness and function after anteroapical aneurysm plication in the sheep. J Thorac Cardiovasc Surg 2000; 119: 115–24.

    Article  CAS  PubMed  Google Scholar 

  82. Konertz W, Hotz H, Dushe S, Braun JP, Stantke K, Kleber FX. Passive containment and reverse remodeling by a novel textile cardiac support device (abstract). Circulation 2000; 102(Suppl): II 683.

  83. Raman J, Power JM, Buxton BE, Alferness CA., Hare D. Ventricular containment as an adjunctive procedure in ischemic cardiomyopathy: Early results. Ann Thorac Surg 2000; 70: 1124–26.

    Article  CAS  PubMed  Google Scholar 

  84. Vaynblat M, Chiavarelli M, Grijalva G, et al. Cardiac binding in experimental heart failure (abstract). Circulation 1995; 92(Suppl): I 380.

    Google Scholar 

  85. Takagi H, Hirose H, Sasaki E, Bando M, Furuzawa Y, Murakawa S, Mori Y. Effect of wrapping tightness on acute cardiac function in dynamic cardiomyoplasty. Ann Thorac Surg 1997; 63: 1706–12.

    Article  CAS  PubMed  Google Scholar 

  86. Mueller XM, Tevaearai HT, Tucker O, Boone Y, von Segesser LK. Reshaping the remodelled left ventricle: a new concept. Eur J Cardiothorac Surg 2001; 20: 786–91.

    Article  CAS  PubMed  Google Scholar 

  87. 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: 482–89.

    Article  CAS  PubMed  Google Scholar 

  88. Rajnoch C, Chachques JC, Berrebi A, Bruneval P, Benoit M-O, Carpentier A. Cellular therapy reverses myocardial dysfunction. J Thorac Cardiovasc Surg 2001; 121: 871–78.

    Article  CAS  PubMed  Google Scholar 

  89. Menasché P, Hagege AA, Scorsin M, et al. Myoblast transplantation for heart failure. Lancet 2001; 357: 279–80.

    Article  PubMed  Google Scholar 

  90. Vale PR, Losordo DW, Milliken CE, et al. Randomized, single blind, placebo-controlled pilot study of catheter-based myocardial gene transfer for therapeutic angiogenesis using left ventricular electromechanical mapping in patients with chronic myocardial ischemia. Circulation 2001; 103: 2138–43.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Probal Ghosh MCh FRCS FETCS FACC FAMS.

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Ghosh, P. Surgery for heart failure. Indian J Thorac Cardiovasc Surg 18, 125–136 (2002). https://doi.org/10.1007/s12055-002-0022-8

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