Abstract
Ventricular remodeling after an acute myocardial infarction (AMI) includes changes in shape and, more importantly, in volume, together with a reduction of the systolic function, measured as ejection fraction or other parameters. Left ventricular volume reduction (LVVR) was conceived to reverse symptoms of heart failure by reducing LV size, improving, as a consequence, the systolic function in patients with remodeled heart after a myocardial infarction, mainly in the left anterior descending (LAD) territory. In the recent era the need for a more physiological shape is associated with the changing pattern of septoapical scars. The reduction of distensibility increases the end-diastolic pressure (and consequently pulmonary pressure) and affects remote zones earlier than in patients with dyskinetic areas. A number of volume-related or shape-related techniques have been described. The outcome of patients who underwent the Dor operation is satisfying. Survival at 5 years ranges from 61.5% to 72.9%. At 5 and 20 years freedom from death due to any cause has been 60% and 36.1%, respectively. Only a few papers have compared volume-related techniques with shape-related techniques. A 7-year survival of 61.5% vs. 72.1%, respectively (P = 0.041) has been reported, and our group has shown improved freedom from cardiac death in patients who underwent shape-related LVVR (86.6% vs. 76.3%, P = 0.032).
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References
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:II18–22.
Liu J, Liu Z, Zhao Q, Chen A, Wang Z, Zhu D. Role of surgical ventricular restoration in the treatment of ischemic cardiomyopathy. Ann Thorac Surg. 2013;95:1315–21.
Cooley DA, Collins HA, Morris GC Jr, Chapman DW. Ventricular aneurysm after myocardial infarction; surgical excision with use of temporary cardiopulmonary bypass. JAMA. 1958;167:557–60.
Menicanti L, Di Donato M. The Dor procedure: what has changed after fifteen years of clinical practice? J Thorac Cardiovasc Surg. 2002;124:886–90.
Dor V, Saab M, Coste P, Kornaszewska M, Montiglio F. Left ventricular aneurysm: a new surgical approach. Thorac Cardiovasc Surg. 1989;37:11–9.
Guilmet D, Popoff G, Dubois C, et al. A new surgical technic for the treatment of left ventricular aneurysm: the overcoat aneurysmoplasty. Preliminary results. 11 cases. Arch Mal Coeur Vaiss. 1984;77:953–8.
Stoney WS, Alford WC Jr, Burrus GR, Thomas CS Jr. Repair of anteroseptal ventricular aneurysm. Ann Thorac Surg. 1973;15:394–404.
Calafiore AM, Gallina S, Di Mauro M, et al. Left ventricular aneurysmectomy: endoventricular circular patch plasty or septoexclusion. J Card Surg. 2003;18:93–100.
Calafiore AM, Mauro MD, Di Giammarco G, et al. Septal reshaping for exclusion of anteroseptal dyskinetic or akinetic areas. Ann Thorac Surg. 2004;77:2115–21.
Shapiro EP, Rademakers FE. Importance of oblique fiber orientation for left ventricular wall deformation. Technol Health Care. 1997;5:21–8.
Helm PA, Younes L, Beg MF, et al. Evidence of structural remodeling in the dyssynchronous failing heart. Circ Res. 2006;98:125–32.
Sallin EA. Fiber orientation and ejection fraction in the human left ventricle. Biophys J. 1969;9:954–64.
Zhong L, Su Y, Gobeawan L, et al. Impact of surgical ventricular restoration on ventricular shape, wall stress, and function in heart failure patients. Am J Physiol Heart Circ Physiol. 2011;300:H1653–60.
Lee LC, Wenk JF, Zhong L, et al. Analysis of patient-specific surgical ventricular restoration: importance of an ellipsoidal left ventricular geometry for diastolic and systolic function. J Appl Physiol. 2013;115:136–44.
Choi HF, D’Hooge J, Rademakers FE, Claus P. Influence of left-ventricular shape on passive filling properties and end-diastolic fiber stress and strain. J Biomech. 2010;43:1745–53.
ten Brinke EA, Witkowski TG, Delgado V, et al. Myocardial collagen turnover after surgical ventricular restoration in heart failure patients. Eur J Heart Fail. 2011;13:1202–10.
Tulner SA, Steendijk P, Klautz RJ, et al. Surgical ventricular restoration in patients with ischemic dilated cardiomyopathy: evaluation of systolic and diastolic ventricular function, wall stress, dyssynchrony, and mechanical efficiency by pressure-volume loops. J Thorac Cardiovasc Surg. 2006;132:610–20.
Di Donato M, Toso A, Dor V, et al. Surgical ventricular restoration improves mechanical intraventricular dyssynchrony in ischemic cardiomyopathy. Circulation. 2004;109:2536–43.
Doenst T, Spiegel K, Reik M, et al. Fluid-dynamic modeling of the human left ventricle: methodology and application to surgical ventricular reconstruction. Ann Thorac Surg. 2009;87:1187–95.
Eisen HJ. Surgical ventricular reconstruction for heart failure. N Engl J Med. 2009;360:1781–4.
Jackson BM, Gorman JH, Moainie SL, et al. Extension of borderzone myocardium in postinfarction dilated cardiomyopathy. J Am Coll Cardiol. 2002;40:1160–7; discussion 8–71.
Calafiore AM, Iaco AL, Kheirallah H, et al. Outcome of left ventricular surgical remodelling after the STICH trial. Eur J Cardiothorac Surg. 2016;50:693–701.
Castelvecchio S, Parolari A, Garatti A, et al. Surgical ventricular restoration plus mitral valve repair in patients with ischaemic heart failure: risk factors for early and mid-term outcomesdagger. Eur J Cardiothorac Surg. 2016;49:e72–8.
Jones RH, Velazquez EJ, Michler RE, et al. Coronary bypass surgery with or without surgical ventricular reconstruction. N Engl J Med. 2009;360:1705–17.
Dor V, Civaia F, Alexandrescu C, Sabatier M, Montiglio F. Favorable effects of left ventricular reconstruction in patients excluded from the Surgical Treatments for Ischemic Heart Failure (STICH) trial. J Thorac Cardiovasc Surg. 2011;141:905–16, 16 e1-4.
Buckberg GD, Athanasuleas CL, Wechsler AS, Beyersdorf F, Conte JV, Strobeck JE. The STICH trial unravelled. Eur J Heart Fail. 2010;12:1024–7.
Holly TA, Bonow RO, Arnold JM, et al. Myocardial viability and impact of surgical ventricular reconstruction on outcomes of patients with severe left ventricular dysfunction undergoing coronary artery bypass surgery: results of the Surgical Treatment for Ischemic Heart Failure trial. J Thorac Cardiovasc Surg. 2014;148:2677–84 e1.
Michler RE, Rouleau JL, Al-Khalidi HR, et al. Insights from the STICH trial: change in left ventricular size after coronary artery bypass grafting with and without surgical ventricular reconstruction. J Thorac Cardiovasc Surg. 2013;146:1139–45 e6.
Calafiore AM, Iaco AL, Amata D, et al. Left ventricular surgical restoration for anteroseptal scars: volume versus shape. J Thorac Cardiovasc Surg. 2010;139:1123–30.
Suma H, Anyanwu AC. Current status of surgical ventricular restoration for ischemic cardiomyopathy. Semin Thorac Cardiovasc Surg. 2012;24:294–301.
Calafiore AM, Iaco AL, Abukoudair W, Penco M, Di Mauro M. Left ventricular surgical remodeling after the STICH trial. Thorac Cardiovasc Surg. 2011;59:195–200.
Isomura T, Hoshino J, Fukada Y, et al. Volume reduction rate by surgical ventricular restoration determines late outcome in ischaemic cardiomyopathy. Eur J Heart Fail. 2011;13:423–31.
Calafiore AM, Di Mauro M, Mazzei V, Angelini G, Teodori G, Wilde P. Midterm results after septal reshaping for anteroseptal scars. Heart Surg Forum. 2004;7:E230–6.
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Calafiore, A.M., Foschi, M., Totaro, A., Pelini, P., Di Mauro, M. (2020). Left Ventricular Volume Reduction. In: Raja, S. (eds) Cardiac Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-24174-2_81
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DOI: https://doi.org/10.1007/978-3-030-24174-2_81
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