1 . 2014

Reverse remodeling of the heart as a method of treatment of patients with dilated cardiomyopathy

Abstract

Organ transplant deficit leads to the search for new solutions to the problem of surgical treatment of patients with cardiomyopathy and severe heart failure. One of the possible methods is reconstructive surgery – reverse remodeling of the heart.

From 2008 to 2013 we have performed 24 reverse cardiac remodeling in patients with dilated cardiomyopathy. The total number of patients operated with this technique was 24 (19 male and 5 female) patients aged 20–75 (average age – 50,7±2,5). All patients had higher heart failure classes (III FC NYHA – 3, IV FC NYHA – 21 patients). Echocardiography before surgery showed cardiomegaly: LVEDP – 7,4±0,9 сm, LVEDV – 277±98 ml, left atrial dimension – 7,2±1,3 сm, LVEF – 29±10%, PASP – 45±15 mm Hg.

Intraoperative mortality was absent. In the early postoperative period after reverse remodeling two patients died. 22 patients were discharged from the hospital. Upon hospital discharge all the patients showed lower heart failure class (I–II FC NYHA) and improvement in functional reserve. The comparative analysis of transthoracic echocardiography indicators revealed reduction in the size and volume of the cavities of the heart, decrease in the pulmonary artery systolic pressure, left ventricular ejection fraction increase compared with the original data. In the late period (observation period up to 5 years) 5 patients died from progression of heart failure, 3 more died from fatal cardiac arrhythmias. Reverse remodeling of the heart is considered to be a promising organ preserving surgery for a certain group of patients, allowing us in some cases not to perform a heart transplant.

Keywords:DCM, heart transplantation, reconstructive heart surgery

Clin. Experiment. Surg. Petrovsky J. – 2014. – N 1. – С. 82–89.