doi:10.1093/mmcts/mmt002 published online 26 February 2013.
Left ventricular reconstruction: update to left ventricular aneurysm/reshaping techniques Serenella Castelvecchio* and Lorenzo Menicanti Department of Cardiac Surgery, I.R.C.C.S., Policlinico San Donato, Milan, Italy *Corresponding author. Division of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy. Tel: +39-2-52774-838/842; fax: +39- 2-52774615; e-mail: [email protected] (S. Castelvecchio). Received 16 January 2013; accepted 24 January 2013
Summary The increase in left ventricular (LV) volume after a myocardial infarction (MI) is a component of the remodelling process and is associated with a poor clinical outcome. Hence, the current management strategy for ischaemic LV dysfunction has been aimed at reversing the remodelling process. Surgical LV reconstruction (LVR) has been introduced as an optional therapeutic strategy aimed at reducing LV volumes through the exclusion of the scar tissue, thereby restoring the physiological volume and shape and improving LV function and clinical status. Until recently, several studies have shown that surgical LVR is effective and relatively safe, with a favourable 5-year outcome. However, in spite of the large amount of reports drawn on various data sets, the additional benefit of LVR to CABG remains debated. We briefly discuss the rationale for surgically reversing LV remodelling through LVR, and, more extensively, the technique and the indications to the best of our knowledge. Keywords: Myocardial infarction • Left ventricular remodelling • Surgical ventricular reconstruction • Cardiac function
INTRODUCTION Despite many breakthroughs in cardiovascular medicine, MI and heart failure (HF) are still among the most major public-health challenges in developed countries. The 5-year survival rate of patients diagnosed with HF is still 60 ml/m2 had approximately a 5-fold increase in mortality compared with those with normal volumes after an MI. Ten years later, the GUSTO-I trial confirmed that an ESVI of ≥40 ml/m2 was an independent predictor of early and late mortalities after a reperfused MI [17]. Based on that, we analysed the impact on survival of a residual LVESVI of ≥ or
Left ventricular reconstruction: update to left ventricular aneurysm/reshaping techniques Serenella Castelvecchio* and Lorenzo Menicanti Department of Cardiac Surgery, I.R.C.C.S., Policlinico San Donato, Milan, Italy *Corresponding author. Division of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy. Tel: +39-2-52774-838/842; fax: +39- 2-52774615; e-mail: [email protected] (S. Castelvecchio). Received 16 January 2013; accepted 24 January 2013
Summary The increase in left ventricular (LV) volume after a myocardial infarction (MI) is a component of the remodelling process and is associated with a poor clinical outcome. Hence, the current management strategy for ischaemic LV dysfunction has been aimed at reversing the remodelling process. Surgical LV reconstruction (LVR) has been introduced as an optional therapeutic strategy aimed at reducing LV volumes through the exclusion of the scar tissue, thereby restoring the physiological volume and shape and improving LV function and clinical status. Until recently, several studies have shown that surgical LVR is effective and relatively safe, with a favourable 5-year outcome. However, in spite of the large amount of reports drawn on various data sets, the additional benefit of LVR to CABG remains debated. We briefly discuss the rationale for surgically reversing LV remodelling through LVR, and, more extensively, the technique and the indications to the best of our knowledge. Keywords: Myocardial infarction • Left ventricular remodelling • Surgical ventricular reconstruction • Cardiac function
INTRODUCTION Despite many breakthroughs in cardiovascular medicine, MI and heart failure (HF) are still among the most major public-health challenges in developed countries. The 5-year survival rate of patients diagnosed with HF is still 60 ml/m2 had approximately a 5-fold increase in mortality compared with those with normal volumes after an MI. Ten years later, the GUSTO-I trial confirmed that an ESVI of ≥40 ml/m2 was an independent predictor of early and late mortalities after a reperfused MI [17]. Based on that, we analysed the impact on survival of a residual LVESVI of ≥ or
