Surgical ventricular restoration is an operation performed on patients with congestive heart failure who have developed scarring or aneurysms in the heart wall and an enlarged heart.
This procedure is used when a weakness is located in the heart, usually in the front part of the heart.
Also known as SAVER (surgical anterior ventricular endocardial restoration), SVR directly addresses the underlying cause for CHF by changing the anatomy of the left ventricle, the heart’s main pumping chamber. Restoring the normal size and shape of the left ventricle and fiber orientation with SVR allows for more normal heart muscle function.
Detailed Description
When a patient has a major heart attack, frequently there is scarring or full thickness loss of heart muscle wall and the muscle becomes replaced by scar tissue. The scar tissue, which does not contract like normal heart muscle, tends to expand.
As the left ventricle and the heart become larger, or dilated, it becomes less efficient as a pumping chamber and the patient goes into progressive heart failure. The predominant cause of disease and death in CHF is ventricular dilation. SVR is one of several operations designed to address this problem.
SVR is a surgical procedure that decreases the size of the left ventricle. The purpose of this operation is to improve the heart’s ability to pump blood throughout the body. It helps decrease stress on the weak heart muscle.
SVR returns the abnormally shaped left ventricle to the more normal elliptical shape and muscle fibers to a more helical fiber orientation, thereby improving heart function, by lowering wall stress and permitting the normal heart to “twist” in its natural movement.
The procedure is performed in conjunction with other operations. The operation itself adds about 20-30 minutes to a regular open-heart surgery that might include bypass and valve replacement.
The Procedure
Before surgery, doctors try to determine the transition area between functioning heart muscle and scar tissue. Then, they aim to reconstruct the heart based on that area of functionality.
After making an incision into the ventricle, an encircling suture is used to exclude scarred tissue overlying the transition zone. After tightening the suture, an oval rim is formed with a raised edge. The opening is then closed with a patch in most cases or by a direct closure.
After a group of heart surgeons in Alabama found 75% of 421 patients were functionally free from heart failure, with a great improvement in their quality of life, 18 months after SVR, experts are saying the operation is “safe and effective.”
The study also showed 89% of patients were still alive, and 85% of them had avoided readmission to hospital for congestive heart failure.
The paper was published in the April 2001 Journal of the American College of Cardiology.
Candidates for SVR, include those with severe heart failure, a very enlarged heart, and areas of scarring that’s causing heart failure to worsen. Those who aren’t candidates for a heart transplant, such as the elderly or those with diabetes may otherwise be eligible for SVR.
Investigators are currently performing SVR and other heart therapies in an international, multi-center, randomized trial, dubbed STICH, which is sponsored by the National Institutes of Health. The goal of the trial is to determine the best treatment for patients with heart failure caused by coronary artery disease.
Last updated: 28-Apr-03
