TY - CHAP M1 - Book, Section TI - Surgical Ventricular Remodeling A1 - Kemp, Clinton D. A1 - Conte, John V. A2 - Yuh, David D. A2 - Vricella, Luca A. A2 - Yang, Stephen C. A2 - Doty, John R. PY - 2014 T2 - Johns Hopkins Textbook of Cardiothoracic Surgery AB - EpidemiologyCongestive heart failure (CHF) is the most prevalent medical problem in Western society as the leading cause of death in the United States. Ischemic cardiomyopathy (ICM) is the leading cause of CHF, affecting 75 percent of patients with CHF.PathophysiologyICM is generally caused by a full-thickness myocardial infarction (MI), followed by ventricular remodeling. This remodeling process can result in progressive dilation of the ventricle, leading to an increase in the end-diastolic diameter and volume, an increase in left ventricular wall stress and oxygen demand, a loss of the left ventricle’s natural elliptical shape with the development of a more rounded form, the development of mitral insufficiency and, ultimately, a worsening of global systolic function.Clinical featuresProgressive CHF due to ICM results in debilitating congestive symptoms, including dyspnea, fatigue, peripheral edema and, in its end stages, acute and/or chronic multisystem organ failure. Classically, patients are candidates for surgical ventricular remodeling (SVR) if they have had an anterior MI, have a large area of akinesis or dyskinesis, and have clinical evidence of CHF.DiagnosticsPreoperative diagnostics include cardiac catheterization with coronary angiography. Other potentially useful diagnostics include myocardial viability and magnetic resonance imaging studies.TreatmentThe surgical goals of SVR include complete revascularization of all viable territories, exclusion of akinetic and dyskinetic segments with a concomitant reduction in the size of the nonfunctioning anteroseptal portion of the heart, recreation of the elliptical shape of the heart, and repair of any valvular incompetence by valve repair or replacement.Outcomes/prognosisSVR has been shown to improve ventricular size, morphology, left ventricular ejection fraction (EF), stroke-volume index, endocrine markers of CHF, ventricular energetics, ventricular synchrony, and mechanical efficiency. Clinically, it results in improved functional capacity (New York Heart Association class) and an excellent 5-year survival in very sick patients. Further study and experience are needed to optimize patient selection and timing for surgical intervention as well as to better define the mechanistic basis behind the beneficial effects of SVR. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesssurgery.mhmedical.com/content.aspx?aid=1104593742 ER -