Surgery and Devices for Congestive Heart Failure

• The surgeon first performs ventriculectomy, which is the removal of a section of healthy heart muscle weighing about three ounces.
• The surgeon then reshapes the heart to a more normal size and form.
• Any faulty heart valves are repaired.

Ventricular remodeling is still relatively new, and mortality rates are very high. Studies on long-term improvement are mixed to date. More research is needed to target the patients who would most benefit.

Surgical Anterior Ventricular Endocardial Restoration (SAVER). A related operation called surgical anterior ventricular endocardial restoration (SAVER), or the Dor procedure (after its inventor), combines elements of ventricular remodeling and coronary bypass surgery. It may be beneficial for those whose heart muscle has been scarred by a heart attack. An early study found that 85% of patients who had the surgery did not need to return to the hospital during an 18-month follow-up period. Additional trials are under way.

Dynamic Cardiomyoplasty

Dynamic cardiomyoplasty is an investigative treatment that has been useful in carefully selected patients with heart failure, although long-term and larger studies are still needed:

• The procedure detaches one end of a muscle from the back and wraps it around the ventricles of the heart.
• After a few weeks, these relocated muscles are conditioned with a pacemaker to behave and beat as if they were heart muscles.

Initial tests indicated that the procedure benefited the failing heart in many ways, including improving systolic pressure, limiting dilation of the heart, reducing heart muscle stress, and possibly reversing unwanted cardiac remodeling. But there have been subsequent problems with heart rhythm disturbances and in conditioning the relocated muscles. One study was stopped because of no difference in survival rates in patients with or without this procedure. Additional experience indicated that it was the restraining effect of the muscle wrap on the weakened heart that may have provided key benefits. Surgeons are now investigating cardiac support devices that cradle the heart in a mesh-like support as a possible new surgical avenue.