Surgical approaches to arresting or reversing chronic remodeling of the failing heart

Research output: Contribution to journalReview articlepeer-review

Abstract

Chronic ventricular remodeling is a central feature of heart failure that strongly correlates with a poor prognosis. Several recent surgical treatments for heart failure may derive benefit by their ability to arrest or substantially reverse this remodeling process. Dynamic cardiomyoplasty involves wrapping the heart with the latissimus dorsi muscle and stimulating the muscle to assist contraction. The wrap itself may provide a constraint helping to limit progressive cardiac dilation and/or assist in reversing this process. Left ventricular assist devices almost completely unload the heart and augment systemic circulation, thereby reducing neurohumoral activation. These combined effects seem to alter the chamber and cellular phenotype, and reversal of some molecular changes are associated with failure. Lastly, the partial ventriculectomy procedure directly reverses remodeling by acute removal of a portion of the lateral wall. Only preliminary nonrandomized trial data are currently available for each of these therapies with larger trials under way. However, early results are intriguing and are yielding insights into these mechanisms.

Original languageEnglish (US)
Pages (from-to)57-66
Number of pages10
JournalJournal of cardiac failure
Volume4
Issue number1
DOIs
StatePublished - Mar 1998

Keywords

  • Dilation
  • Dynamic cardiomyoplasty
  • Heart failure
  • Partial ventriculectomy
  • Remodeling
  • Ventricular assist device

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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