[HSF] surgical ventricular restoration

Fri Jan 11 20:11:21 EST 2008

I am more than content to let you and Hal explain the value of cardiac MR and SVR. Those of you that have tried to understand me may have some insight as to why I find the eloquent and/ or passioned expression of my views a self defining success.

Thank you both. 

If I have an original idea I will try to point it out.

tea 

----- Original Message ----
From: Ani Anyanwu <anianyanwu at hotmail.com>
To: openheart-l at lists.hsforum.com
Sent: Friday, January 11, 2008 9:41:48 AM
Subject: RE: [HSF] surgical ventricular restoration

Tea can answer in detail but in summary it gives information about both structure (anatomy), function and viability. You can work out the dyskinetic area, work out the ventricular dimensions and volumes (to justify need for SVR, work out the volume contributed to by the aneurysm or dyskinetic area, work out a true ejection fraction, work out the residual ventricular volume to expect after resection of the dyskinetic area and indeed work out how much you can safely resect (so as not to end up with too small a ventricle - for example if by MRI you computed that a patient will be left with a ventricular volume of 80mls (extreme just for illustration) then you would not do the procedure). Obviously you can also easily confirm what is scar and what is not and what is viable and what is not. Also you can measure the RV ejection fraction which is a prognostic marker for survivability in these cases. Post op MRI will demonstrate one has achieved the set
 objective by beautifully showing restoration of the elliptical shape to the heart, elimination/reduction of the dyskinetic or akinetic segment, reduced ventricular volume and improved function etc etc

It is difficult to explain but once you start using MRIs you will wonder how you actually survived without them and will place far more value on them than you will the echocardiogram or cineventriculogram.

Ani

> Date: Fri, 11 Jan 2008 20:57:07 +0530> From: prasannasimha at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] surgical ventricular restoration> CC: > > I have one question what is so magical about a cardiac MRI versus say a> radionucliide scan ?> Prasanna> > On Jan 11, 2008 8:35 PM, Ani Anyanwu <anianyanwu at hotmail.com> wrote:> > > Hal> >> > Some would argue though that without cardiac MRI you cannot be doing the> > careful pre-op evaluation that you recommend.> >> > I agree though that the procedure can be effective but I would not go so> > far as using the miraculous improvements in EF as evidence of such. Such> > improvements were also seen with cardiomyoplasty and Batista or indeed CABG> > alone so I would not go so far as saying the improvements are dramatic and> > it implies procedure is 'highly effective'. If it was that effective it> > would have been unethical to randomize patients in the STITCH trial and I> > personally have not
 heard of any IRB or ethics committee that refused> > participation in the STITCH trial because the procedure is 'highly> > effective' so would be unethical to deny patients.> >> > Remember also as per our previous discussions the best way to get good> > results with the SVR (and which is why many are sceptical of the data from> > Europe) is to operate on patients who do not need it - any high risk low EF> > CABG just do an SVR and of course results will be good (they would also be> > good without an SVR) - and that is my problem with the marketing of the> > procedure as centers offer this without the essential preop evaluation you> > mentioned. These are different from the typical patients you would do an SVR> > on but I suspect if you look countrywide it is these patients (questionable> > indication) that prevail in SVR series.> >> > What if (as I suspect) the STITCH trial reports and shows no survival> > difference between SVR and CABG alone (or even
 worse lower survival with> > SVR) will you then revise your opinion or will you (as we surgeons do)> > ignore the data and still believe what you currently believe?> >> > Ani> >> >> >> >> > > From: Hgrmd at aol.com> Date: Fri, 11 Jan 2008 07:15:16 -0500> Subject: Re:> > [HSF] surgical ventricular restoration> To: OpenHeart-L at lists.hsforum.com>> > CC: > > Tea,> I agree with you (for once) about SVR. Ani sees failed ones,> > and thus > probably has a skewed view of its efficacy. I've successfully> > done SVR's on > lots of patients with global EF's of 10-15%. They often have> > remote postop EF's > in the 30-40% range and become essentially> > asymptomatic. SVR is no gimmick. > However, it is a dangerous operation> > (I've killed a couple) that requires > careful preop and intraop evaluation> > in order to get a good result.> > Hal> > > > **************Start the year> > off right. Easy ways to stay in shape. >> >
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