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Home » Left Ventricular Restoration

Left Ventricular Restoration

Left ventricular restoration is a surgical procedure performed to treat congestive heart failure. During a heart attack, some muscles in the wall of the heart die, forming a scar, which later weakens and bulges like a blister or a balloon (aneurysm) during a heartbeat. A scar and/or aneurysm decrease heart efficiency and result in the heart compensating by working harder and causing it to enlarge later. The procedure involves the repair of the left lower chamber (left ventricle) of the heart that has enlarged, back to a size and shape that is as near normal as possible, for it to pump blood efficiently.

Patients who might benefit from the procedure:

  • Those who had a previous heart attack, resulting in scar formation or aneurysm in the left ventricular wall.
  • Those who have signs and symptoms of congestive heart failure such as shortness of breath, easy fatigability, leg oedema (enlarged legs due to retained fluids) that don’t respond to medication.
  • Those who have symptoms of severe chest pain (angina) due to coronary artery disease that don’t respond to medication.
  • Those who have accompanying valve problems.

Presence of any combination of the above needs assessment by a heart specialist or surgeon.

Tests

The following tests are recommended to determine if you are a candidate for the procedure:

  • Echocardiogram (ECHO): This test uses sound waves and helps determine the size and efficiency of the heart.
  • Cardiac catheterization in conjunction with fluoroscopy: A plastic tube (catheter) is inserted through a puncture in the big artery of the groin and slowly navigated upwards towards the heart. An X-ray contrast medium (which appears white on the X-ray) is then injected through this tube. This determines the efficiency of the heart’s blood vessels. Blockage appears as sudden interruption of contrast media flow.
  • MRI (magnetic resonance imaging): Images of the heart are studied using sound frequencies, magnets and a computer. This is the best determining test for surgical intervention.

Other names for left ventricle restoration

Some of the names listed below may be derived from a specific technique or from the name of the surgeon who first came up with the technique:

  • Left ventricular reconstructive surgery
  • Surgical ventricular restoration
  • Dor procedure
  • Left ventricular infarct exclusion surgery
  • Surgical anterior ventricular endocardial restoration
  • Left ventricular aneurysmectomy reconstruction
  • Left ventricular remodelling
  • Endoventricular circular patch plasty repair

Procedure

The procedure is performed under general anaesthesia. The chest is opened in the middle to expose the heart and the patient is put on a heart-lung machine. This machine temporarily replaces the function of the heart and lungs.

The heart is then made to stop by lowering its temperature or by injecting a substance, which is usually a special kind of potassium solution. An incision or cut is made where the scar is, deep down into the innermost layer of the heart and its interior is assessed.

The scar is usually on the front of the left lower chamber or ventricle.

The actual size of the heart is measured. The goal or target size and shape is determined by using a plastic model shaper, which is inserted into the left ventricle.

The size of the patch (if needed) is then determined. The material used for this is called dakron. The patch is sewn just between the inner layer of the heart and the outer scarred layer.

Your doctor will then make reinforcing sutures on the outer layer, but excluding the scar.

Usually, the heart beats again on its own after the procedure. In cases when it does not, your doctor will massage it gently or apply mild electric shocks.

Once the heart resumes beating, the heart-lung machine is withdrawn, and the chest is sewn close.

There are different variations of this technique. In cases where a patch is not required, a purse string suture is made two or more times around the cut or the incision, in the layer below the scar tissue. Pulling on the sutures will tighten the wall, decreasing the size of the heart (just like a pouch bag closed by a drawstring).

Some surgeons may choose to remove the scar tissue, and the hole created is patched.

It is during this procedure that faulty heart valves are repaired, and in order for the heart to have improved blood supply, coronary artery bypass graft (CABG, grafting healthy blood vessels where there is blockage) is also done.

After surgery

IV fluids that have been started before the operation are continued post-surgery. You will be placed in a recovery or intensive care unit, hooked with oxygen and other devices that will monitor your heart and the lungs, as well as drainage from the operation site. You will be given medications, such as pain relievers and antibiotics. You will recover after a few days.

During this time, you will be started on cardiac rehabilitation, which is a program that helps educate and counsel heart patients regarding exercise and healthy living after a cardiac event. In approximately five to seven days, you are ready for discharge.

Things to consider upon discharge

Just before going home, a team member or your doctor will give detailed instructions regarding the following:

  • Wound care: You may choose to have a nurse go to your home and care for your wound or you will be given detailed instructions on cleaning and caring for your wound.
  • Possible complications or signs to look out for: You will be instructed to look out for complications such as infection, bleeding, or severe chest pain that are not relieved with medication.
  • Exercise and other physical activities: You may be made to continue cardiac rehabilitation, which has been started in the hospital.
  • Follow-ups
  • Medications: You will be asked to maintain or continue taking your heart failure medications.
  • Diet: You will be informed about restrictions (usually salt intake and fluids) and of recommended food.

Generally, if you feel anything you think is not right, call your doctor right away.

Overall outlook

Most of the patients who have undergone left ventricle restoration have experienced an improvement in their overall health compared to before surgery.