Batista introduced the partial left ventriculectomy (PLV), which is based on physics alone. With experience, it has been found that the extent of myocardial disease and viability of retained muscle is an important determinant of early and late survival. Although the PLV has been almost abandoned in many countries following the negative message from the Cleveland Clinic, it is still alive in Japan with a refined concept, surgical technique and patient selection. In a series of 63 patients undergoing PLV for idiopathic dilated cardiomyopathy since 1996, operative mortality was 9.5%, and 1-, 3- and 5-year survival rates were 71.1%, 56.2% and 45.9%, respectively. Improved survival has obtained by using appropriate patient selection and concomitant restrictive mitral annuloplasty (1-, 3- and 5-year survival rate =86.5%, 78.6% and 59.4%, respectively, in the most recent 33 patients). Because of insufficient availability of donors for heart transplantation, nontransplant cardiac surgery for medically refractory heart failure is important. Ventricular restoration procedures, including PLV, should be seriously considered as an important option for endstage heart failure. (+info)
Overlapping left ventricular restoration.
Cardiac transplantation, a final option of treatment for refractory heart failure, has not been a standard procedure in Japan especially, mainly because of the shortage of donors. However, surgical methods to restore native heart function, such as surgical ventricular restoration (SVR), are often effective for these cases. The Dor procedure has been used for ischemic cardiomyopathy cases presenting with broad akinetic segments. This is a fine method to exclude the scarred septum and to reduce the intraventricular cavity by encircling purse-string suture, but it may produce a postoperative spherical ventricular shape as a result of endoventricular patch repair. Also, partial left ventriculectomy is not recommended for non-ischemic dilated cardiomyopathy cases for now. A modification of these SVR and surgical approaches to functional mitral regurgitation has been named "overlapping ventriculoplasty" without endoventricular patch and resection of viable cardiac muscle, and "mitral complex reconstruction", which consists of mitral annuloplasty, papillary muscle approximation, and suspension. Although the long-term prognosis of these procedures is undetermined, they could be an important option, at least as an alternative bridge to transplantation. This review will describe the concepts and some technical aspects of these procedures for the end-stage heart. (+info)
Surgical treatment for heart failure: left ventricular restoration for cardiomyopathy.
Congestive heart failure has become a major problem and the only surgical treatment for end-stage heart failure caused by dilated cardiomyopathy (DCM) had been heart transplantation. However, because of the shortage of donors, several procedures for non-transplant surgery have been developed. Published literature on left ventricular (LV) restoration was searched to review the new surgical procedures for treating patients with ischemic or non-ischemic DCM. LV restoration was initiated in the 1980s for repairing LV aneurysm. In the 1990s several surgical procedures were introduced for treating DCM, and the new evolving surgical treatment plays an important role in the management of DCM in the 21st century. (+info)
Acute outcomes of MitraClip therapy for mitral regurgitation in high-surgical-risk patients: emphasis on adverse valve morphology and severe left ventricular dysfunction.