Ventricular restoration surgery treats congestive heart failure and improves your quality of life. If you have had a major heart attack, areas of the heart muscle can turn to scar tissue. This scar tissue does not contract (beat) with the rest of the heart and can cause your heart to pump blood in a very inefficient manner. Removal of this area of scar tissue and restoring your heart to a more normal shape and size can improve the beating efficiency and help with the symptoms of congestive heart failure.
You may be a candidate for ventricular restoration surgery if you have an enlarged heart due to a heart attack or an aortic aneurysm and left ventricle scarring, heart failure caused by inefficient heart pumping, or symptoms of congestive heart failure that are not relieved by medication and lifestyle changes.
Physicians at The Ohio State University Wexner Medical Center were involved in a three-year study of more than 600 patients with severe chronic heart failure. Patients in the study had ventricular restoration surgery. Ohio State surgeons contributed the greatest number of patients to this large multi-year, international study. Overall survival of patients in the study was 89 percent. The most recent data indicates that 91 percent of patients were functionally improved or free of the symptoms of congestive heart failure.
The Ohio State University Wexner Medical Center is a training site for ventricular restoration surgery.
What Is Ventricular Restoration Surgery?
Until recently, congestive heart failure treatment only addressed symptoms of the debilitating disease. Ventricular restoration surgery is the first procedure to treat the disease itself. In this procedure, the surgeon opens the left ventricle (the chamber of the heart that is responsible for pumping blood out from the heart to the entire body) and removes the scarred, nonfunctioning tissue. To assist in the reconstruction, a cow-tissue patch may be used as an implant to replace the tissue that is removed. This process restores your damaged left ventricle to near-normal size and condition.
Why Would You Have a Ventricular Restoration Surgery?
Congestive heart failure, a common and serious heart disorder, is the result of the heart not being able to keep up the workload of pumping blood to the lungs and the rest of the body. The heart’s left ventricle works harder than normal to compensate for this deficit, and becomes enlarged and inefficient. Symptoms of congestive heart failure include shortness of breath, fluid retention, and loss of strength and stamina. When symptoms worsen, you may need hospitalization. Approximately 35 percent of patients die within a year of their first hospital admission for congestive heart failure.
Traditionally, the treatments for symptoms of congestive heart failure have been medications; high-risk coronary bypass surgery, often requiring valve repair or replacement; ventricular assist devices (VADs) for severe cases; and, rarely, heart transplant. These therapies do not treat the congestive heart failure, they only treat the symptoms.
If your symptoms of congestive heart failure are so severe that you cannot walk short distances or up a flight of stairs without becoming short of breath, or you have problems with fluid retention in your legs or lungs and your cardiologist does not think that medical therapy is working, you may be a candidate for more aggressive surgical management.
Your evaluation may include a cardiac MRI or an echocardiogram. If these advanced imaging studies show large areas of scarring, particularly if the areas have started to “balloon out” (become a ventricular aneurysm), you may be a candidate for ventricular restoration surgery. Such surgery is often performed at the same time as coronary artery bypass graft (CABG) or mitral valve repair or mitral valve replacement surgery.
What to Expect During Ventricular Restoration Surgery
Preparing for Your Procedure
Prior to your ventricular restoration surgery, you meet with your physician to discuss your medical history, the medications you take and any questions you have.
You may have tests including:
- Echocardiogram (also called echo) – This test uses sound waves to assess the function and structure of the heart muscle and valves.
- Cardiac MRI (cardiac magnetic resonance imaging or CMR) – A noninvasive, sophisticated imaging procedure that uses large magnets and a computer to produce detailed images of the structure and function of the heart while it is beating.
- Cardiac catheterization – A procedure to check for problems in coronary arteries. A long, thin tube (catheter) is inserted into an artery or vein in the groin, arm or neck, then threaded to the heart. The physician injects a contrast solution into the artery and takes X-rays to check for blockage and other abnormalities.
During Your Procedure
You’ll receive anesthesia (medication to make you sleep) during the procedure. The surgeon makes an incision in your chest and gains access to your heart through your breastbone. You are connected to a heart-lung machine that will take over the function of your heart and lungs during the procedure.This allows the surgeon to stop your heart to make it easier and safer to work on your heart. After making an incision in your ventricle, the surgeon locates the damaged tissue and removes it from your heart. The edges that make the hole are closed together directly, or a small tissue patch is used to help close the defect.
After removing you from the heart-lung machine, several small drainage tubes are put in place, your chest incision is closed, your breastbone is brought together with stainless steel wire, and you are moved to the intensive care unit. You have a breathing tube in place typically only until you are awake to breathe on your own.
After Your Procedure
You usually remain in the hospital for five to seven days. Typically, you get out of bed by the next day and are allowed to start eating. After several days, the drainage tubes are removed. A cardiac rehabilitation team member helps you become more active while you are still in the hospital to regain your strength and prepare you to go home. Once you go home, it is important that you have close follow-up care with your heart specialists. Depending on how you feel and if there is someone who can help keep an eye on you at home, you may need a short stay in a rehabilitation center near your home.