J.Jpn. Surg. Soc.. 109(4): 215-219, 2008

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Feature topic

SEVERE CONGESTIVE HEART FAILURE

Surgical interventions for severe heart failure refractory to medical treatment include the implantation of an artificial heart, tissue engineering, and a myocardial substitute, in addition to conventional coronary revascularization and reduction mitral annuloplasty (RMAP) for functional mitral regurgitation (FMR). Remarkable progress has been made in these surgical methods, but they have not necessarily reached a satisfactory level for clinical application. Cardiac transplantation, the final treatment option for refractory heart failure, has not become a standard procedure, especially in Japan, due to a shortage of donors. However, surgical methods to restore native heart function, such as left ventriculoplasty (LVP), are often effective for those with extremely low cardiac function. Although the long-term prognosis after these procedures has not been determined, they are considered to be an important treatment option, at least as an alternative or biologic bridge to transplantation or artificial heart implantation. LVP is a surgical method to reduce wall stress and improve systolic cardiac function by reducing the left ventricular cavity and remodeling the spherical ventricle into an elliptical shape. Because tethering of the valve leaflets responsible for FMR cannot be corrected by RMAP alone, it appears necessary to repair the total mitral complex to prevent recurrence of FMR.

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