Cardiac reverse remodeling in dilated cardiomyopathy patient as a «prolonged bridge» to the orthotopic heart transplantation
Abstract
Patients with non-ischemic dilated cardiomyopathy (DCM) account for about half of the candidates for orthotopic heart transplantation. This approach is considered the most effective DCM treatment despite the fact that 10-year survival after heart transplantation does not exceed 50–60%.This rate remains stable regardless of the improvement of surgical techniques and new medication, and it drives development of the alternative approaches for DCM treatment.
Cardiac resynchronization therapy, implantation of the left ventricular assist devices (LVAD), and organsparing surgical reverse heart remodeling technics might be considered as such alternatives.
Here we present an example of such a reconstructive intervention providing a 72-month “prolonged temporary bridge” before an orthotopic heart transplantation. A reverse remodeling operation was performed on a 58 y.o.female patient with DCM, severe heart failure (NYHA III–IV) and indication for the heart transplantation.
This operation resulted in a stable improvement in clinical symptoms, and reduction of the class of heart failure from class III–IV to class II (NYHA). Later on hemodynamic parameters began to gradually but steadily decline, and she underwent orthotopic heart transplantation in 4 years after the reverse remodeling operation.
Reverse surgical heart remodeling allows us create the long-term “bridge” to the heart transplanta- tion. It is likely that such a surgical protocol can also be used before implantation of a pumping device as a destination therapy. Further prospective research is needed to clarify selection criteria and long-term results of the organ sparing reconstruction of the all affected cardiac structures including the myocardium.
Keywords:dilated cardiomyopathy, cardiac reverse remodeling, heart transplantation, genetic counselling
For citation: Dzemeshkevich S.L., Frolova Yu.V., Trekova N.A., Eremenko A.V., Babaev M.A., Malikova M.S., Dzemeshkevich A.S., Dombrovskaya A.V., Bukaeva A.A., Dymova O.V., Shestak A.G., Morozova M.M., Zaklyazminskaya E.V. Cardiac reverse remodeling in dilated cardiomyopathy patient as a «prolonged bridge» to the orthotopic heart transplantation. Clin Experiment Surg. Petrovsky J. 2019; 7 (3): 31–9. doi: 10.24411/2308-1198-2019-13003 (in Russian)
Received 25.06.2019. Accepted 25.07.2019.
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