Publication:
Surgical Technology International XVII - Cardiovascular Surgery
Article title:
Medium-Term Results of Surgical
Ventricular Restoration with
Papillary Muscle Realignment:
Providing Additional Benefits in
Enlarged Ischemic Left Ventricle
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Author(s)
R. Unnikrishnan Nair, F.R.C.S.
Consultant Cardiothoracic Surgeon,
Department of Cardiac Surgery
Diane Barker, M.R.C.P.
Cardiology Specialist Registrar,
Department of Cardiology
Sanjay Kumar, F.R.C.S.
Registrar in Cardiothoracic Surgery,
Department of Cardiac Surgery
Kayala Javengula, F.R.C.S.
Registrar in Cardiothoracic Surgery,
Department of Cardiac Surgery
Lip Bun Tan, F.R.C.P.
Consultant Cardiologist,
Department of Cardiology
Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
Abstract
In 2001, we described a new surgical technique of surgical ventricular restoration (SVR) in severe heart failure by papillary muscle re-alignment and volume reduction. This procedure has been offered in our institution to patients with severely impaired left ventricular function. Here we examine our mid-term results and also compare them with a similar cohort of patients who had coronary artery bypass grafting (CABG) only. Between 1998 and 2005, 30 patients underwent SVR by papillary muscle realignment with coronary artery revascularization at our institution. A subset of 20 patients had their left ventricular volume measured by echocardiogram and MRI scan, and a maximal cardiopulmonary exercise test was performed before and after the operation. An unselected consecutive cohort of patients with matching age, gender, and hemodynamic status who underwent CABG only without SVR was tested using the same protocol and the results were compared. We noticed that there was a significant advantage for patients who had additional SVR over patients who had CABG only. The observed improvement in those who had SVR may be due to reduced metabolic mismatch as a result of reduced wall tension and normalization of the apical twist of the left ventricle. We believe this would provide a form of surgical treatment for heart failure secondary to ischemic cardiomyopathy at a time of reduced donor organ availability for transplant.