Left Ventricular Volume Reduction

Abstract

Ventricular remodeling after an acute myocardial infarction (AMI) includes changes in shape and, more importantly, in volume, together with a reduction of the systolic function, measured as ejection fraction or other parameters. Left ventricular volume reduction (LVVR) was conceived to reverse symptoms of heart failure by reducing LV size, improving, as a consequence, the systolic function in patients with remodeled heart after a myocardial infarction, mainly in the left anterior descending (LAD) territory. In the recent era the need for a more physiological shape is associated with the changing pattern of septoapical scars. The reduction of distensibility increases the end-diastolic pressure (and consequently pulmonary pressure) and affects remote zones earlier than in patients with dyskinetic areas. A number of volume-related or shape-related techniques have been described. The outcome of patients who underwent the Dor operation is satisfying. Survival at 5 years ranges from 61.5% to 72.9%. At 5 and 20 years freedom from death due to any cause has been 60% and 36.1%, respectively. Only a few papers have compared volume-related techniques with shape-related techniques. A 7-year survival of 61.5% vs. 72.1%, respectively (P = 0.041) has been reported, and our group has shown improved freedom from cardiac death in patients who underwent shape-related LVVR (86.6% vs. 76.3%, P = 0.032).