[HSF] surgical ventricular restoration

Thu Jan 10 19:36:00 EST 2008

I am surprised that Gabi does not think we talk about SVR. It seems to me that I am always talking about ventricular structure and function and tend to censor myself to avoid sounding like a commerial.

Interesting analysis of the dynamics of an SVR program, Ani. How is that different than the dynamics of many transplant programs?

Everyone does "SVR" with a less sexy name, maybe so. I guess we all "do" mitral repairs, aortic surgery, Bentalls, and off pump surgery too when indicated. Why some do more is well, unclear, or perhaps better said why some do less is equally unclear. 

We have had many discussions as to the importance or lack of the same for ischemia, progressive volume loading (dilation), and "structural" abnormalities on patient mortality and less on long term ventricular function.  They mostly tend to die over time with or without treatment. I bet we will see some major fault lines appearing in geography of the current consensus standards that we think we have now confirmed. Clearly ventricular replacement works for the few. What do we do for the many and the elderly squash players?

Undoubtedly SVR is for ishcemic disease and present and previous ischiemia is thus the "driving force" behind successful SVR. I might be wrong, as I have been wrong before, but if I were to "need" CABG with a dilated ventricle (sorry too much information) with a poor EF, I would like to have someone think about my regional function, ventricular volumes, and mitral regurgitation before they did the CABG or sent me for "transplant evalution". This is precisely what "SVR" is all about. We might also find an occasional ventricular aneurysm, too.

tea

teas

----- Original Message ----
From: Ani Anyanwu <anianyanwu at hotmail.com>
To: openheart-l at lists.hsforum.com
Sent: Thursday, January 10, 2008 7:39:08 AM
Subject: RE: [HSF] surgical ventricular restoration

Gabi

Every surgeon offers this operation only they may not call it by such a sexy name. We actually did discuss this as length sometime last year. The SVR thing is mainly a marketing gimmick but it is also a good operation for the right indication. The problem is that it is being marketed as a cure for heart failure but it rarely is so. There are actually very few patients with heart failure for whom this is the solution. In general most patients having SVR are patients with coronary artery disease having CABG for other indication who also happen to have 'akinesis' or dyskinesia of anterior or apical segments and an SVR is done with the CABG (but the CABG drove the surgery). There are much less patients where cardiac restoration is the primary indication for surgery (it works well in this context). 

I work in a transplant center and see many many heart failure patients and is rare to see a patient with an indication for an SVR. I speak to other transplant surgeons who tell me the same thing. To explain this discrepancy with some centers doing a lot and some rarely: maybe there is selection bias (patients are not sent to us till alll options exhausted) or alternatively I suspect there is in some centers excessive application of therapy when not indicated. Another thing to note is hospitals do these adverts to get patients through the door. The majority of patients responding to the advert will not be candidates for SVR, but they will still generate revenue from ICDs, diagnostic tests, other conventional surgery.

As to the main question you ask - whether it works - there is a randomized trial which just closed which should help answer that. My suspicion is that other than the patient with an aneursym, this procedure will go the way of the Batista. Tea has an interest in SVR and hopefully will give the other side of the coain as I am sure my biases are making me misrepresent the operation!

Ani

> From: gabiford at hotmail.com> To: openheart-l at lists.hsforum.com> Subject: RE: [HSF] surgical ventricular restoration> Date: Thu, 10 Jan 2008 13:19:04 +0000> > > From: prasannasimha at gmail.com> It is a procedure with many hats which has been done for years under the> name of Jatene,Cooley, Dor etc etc .in various formats.> > Yes, but is it an effective treatment of heart failure? > Our center does not offer this operation. I'm not sure why not, but usually our surgeons have good reasons why they do or do not offer particular procedures. Hence I was a bit suspicious about the efficacy. > Also, this operation is never a topic here on HSF.> > Gabi_______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and
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