Ventricular Remodeling Surgery

Surgical Ventricular Reconstruction (SVR)

Surgical ventricular reconstruction, or SVR, reduces the size of a patient's failing, enlarged heart to ensure that blood is pumped out of the heart and through the body efficiently enough that the patient can take part in her full, active life.

In a healthy patient, oxygen-rich blood returning from the lungs is pumped through the heart and out to the rest of the body. But in the hearts of one in four patients who have suffered a heart attack, the left ventricle dilates from its natural football shape into a rounder, basketball shape. This new shape interferes with the heart's ability to contract strongly enough to push the returning blood through the heart. Instead, blood pools in the lungs causing a variety of symptoms that compromise the quality of patients' daily lives including:

• Fatigue
• Waking up in the middle of the night short of breath
• General difficulty catching their breaths
• Rapid heart beat
• Chest pain

During SVR the cardiothoracic surgeon will reshape the patient's heart so it can contract more effectively and restore a free flow of oxygen-rich blood throughout the body. Following SVR, patients who were once winded by their favorite activities from gardening to golf to scooping up a little one at a family gathering can return to these activities free from chest pain and shortness of breath.

Pioneering SVR at Montefiore-Einstein

Montefiore-Einstein Heart Center is a national leader in surgical ventricular reconstruction. For those patients that are cleared for the SVR procedure, Montefiore-Einstein has a greater than 95 percent success rate, and Montefiore-Einstein Cardiothoracic Surgery Department Chairman Dr. Robert Michler was among the first surgeons in the United States to perform SVR as part of the STICH trial sponsored by the National Heart, Lung and Blood Institute(NHLBI) few surgeons have been practicing SVR longer. Currently, he is the chairman of the Surgical Therapy Committee for the STICH trial.  This trial tests which procedures most effectively treat patients with ischemic heart failure. By helping to pioneer the SVR procedure, Dr. Michler has secured the respect of his colleagues throughout the country.

How is SVR performed?

A patient undergoing SVR is wheeled into the operating room and put to sleep by an anesthesiologist who specializes in cardiac patients. To gain access to the heart, the surgeon will use a saw to open the breastbone.

The patient is put on a heart-lung bypass machine that will take over breathing and blood-pumping duties. To transition to the heart-lung bypass, patients are given a temporary blood thinner to prevent clots, then a tube is placed in the aorta and the right atrium. The deoxygenated blood collected in the right atrium is routed to the heart-lung machine where carbon dioxide is removed and oxygen is added. This oxygenated blood is pumped back into the aorta where it is distributed to the rest of the body. At this point, the surgeon will turn off the ventilator and stop the heart with an injection of a high potassium electrolyte solution.

At the start of the SVR procedure, the surgeon will make an incision into the heart to distinguish scarred tissue from healthy muscle. Once these determinations have been made, the surgeon will reshape the heart by reuniting healthy tissue around a balloon shaper in a manner that excludes scarred tissue like a pleat. This means only strong, healthy muscle is involved in contracting the heart.

Coronary artery bypass surgery is generally performed prior to the reconstruction of the heart. Once the operation is complete, the surgeon will restore blood flow to the patient's heart and the heart will resume beating on its own. The surgeon will disconnect the heart-lung bypass machine only after the heart has resumed a strong beat.

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