Ventricular Remodeling

New Hope for Heart Failure Patients 

What’s commonplace in heart repair today was the stuff of science fiction a few short decades ago. Coronary bypass surgery was in its infancy, and coronary stents and balloon angioplasty were unknown to the general public. Procedures that once seemed impossible have now become ordinary, and the 550,000 Americans diagnosed each year with heart failure have a better chance of surviving than ever before. 

But with a 10-year survival rate of less than 50 percent for most patients, researchers began to take a hard look at what could be done to fix the damage. What if we could remodel the heart – take it back to the size and shape it was before the heart attack occurred? What if we could give it a facelift of sorts – removing the lifeless areas scarred in the attack? It may sound like science fiction, but a surgical procedure first tested in the 1950s has developed into surgical ventricular remodeling now available at Genesis.

When a heart attack occurs, a part of the heart – usually in the left ventricle – gets damaged and a small scar forms. Over time and with each heartbeat, the scar thins out, causing a bulge and thinning in the ventricle wall.

“When this happens, there is no longer a muscle there; it’s all scar,” explained Eduardo Jorge, M.D., cardiothoracic surgeon with Cardiothoracic Surgical Services of Zanesville. “It’s not contributing to the function of the heart. When the good part of the heart beats, some of the energy is going to fill this bulge and is wasted. Also, the bulge pulls apart the papillary muscles that support the mitral valve, contributing to leakage in that valve.”

And, as the scar grows, it changes the shape of the heart. What once was a cone-shaped heart, effectively pumping blood through its natural wringing action, is now morphed into a rounded shape. The heart’s wringing function becomes less efficient and normal levels of blood flow cannot be maintained. When there is not enough blood flow to the vessels inside the heart, more of the heart muscle will die.

“With left ventricular remodeling, we are trying to make the heart smaller and more efficient, change the shape to put that wringing action back in line and correct the misalignment of the papillary muscles to prevent leakage in the mitral valve,” stated Dr. Jorge. 

Dr. Jorge is the first to admit the procedure sounds futuristic. “We are actually taking a heart that has grown too large and too round, and we’re reconstructing it to bring it back to an efficient size and shape,” he said. “For those patients who are at serious risk from the effects of scarring, we are giving them back a quality of life that is dramatically improved.”

In a world that’s seen cellular phones, hand-held computers and men on the moon, maybe remodeled hearts isn’t so hard to imagine after all.

What Happens During Ventricular Remodeling Surgery

It is important to remember that left ventricular remodeling is done after a heart attack happens: not every patient is a candidate for the surgery.

  • A heart/lung machine takes over for the heart, removing and oxygenating the blood.
  • A balloon is inserted inside the heart, its size calculated to match the heart size and shape requirements for that patient.
  • A circular suture is inserted to connect the opening for the patch and to bring the heart back to its correct conical shape, using the balloon as a guide.
  • Once the patch is in place, the balloon is removed and the heart maintains its remodeled size.