Heart failure is often caused by ischemic heart disease that causes enlargement of the heart's main pumping chamber, the left ventricle. SVR means Surgical Ventricular Restoration. This surgery is for people who have had a heart attack in the anterior (front) area of their heart.
SVR removes pieces of damaged heart muscle that do not move properly when the heart beats. This "down-sizes" the heart back to a more normal size and shape.
People with CHF who have fairly large dysfunctional areas of heart muscle (over 35%); and have adequate muscle function in other areas of the heart (inferior and lateral); with an ejection fraction less than 35%; and with left ventricular end-systolic volume more than 60 ml/m2.
The dysfunctional areas of heart muscle are identified before surgery. Echo or MUGA is used to estimate the area of dysfunctional heart muscle, and to measure how well the rest of your heart muscle is working. MRI and cath, or MUGA measures ventricle size.
After cutting open the heart's left ventricle, damaged areas are removed and stitches used to reshape the ventricle. The now-oval opening in the ventricle is repaired and closed with a patch.
Any needed mitral valve repair is done and any restoration of blood flow, like CABG (bypass surgery), is also done during the same surgery.
The Batista procedure reduces heart size by removing a section that may include some good heart muscle. SVR specifically removes only parts of the heart muscle that don't contract properly when the heart beats.
The CorRestore System includes a heart patch of tissue from a cow's heart with a ridged inner ring that is flexible, surrounded by a shaped outer rim. This patch was designed to fill the irregular contours of the thick-walled parts of the heart usually still damaged after a heart attack followed by angioplasty.
The patch's features guard against leaking. The sizer tool also makes it faster and easier to tell what size patch to use.
A 3-year trial of 662 SVR patients has been completed. The overall 3-year death rate was 11% and readmission to the hospital with heart failure was only 11%. Annual hospital admission rate for class 3 and class 4 CHF patients is usually more than 40%, and 24% are admitted at least twice each year.
After surgery, ejection fraction rose from 30% to 40%, and left ventricular end systolic volume went down from 96 to 62 ml/m2. In the 355 patients for whom heart class was reported at the last follow-up, 91% were improved or free of congestive heart failure symptoms. At 3 years, survival was 89%.
Left ventricle with non-beating areas
The left ventricle is opened
Feeling the heart to know where to put the patch
Preparing for the patch with sutures
The patch sizer - patches come in 3 different sizes
Patch sizer being used
CorRestore patch
CorRestore patch - flip side
Patch being prepared for sewing in place
Patch in place and being securely fastened
Final sewing of patch to heart
All done
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