MUNICH — A novel surgical method reduces the left ventricular volume of patients with cardiomyopathy without using ventriculectomy.
The surgery realigns the papillary muscles of the left ventricle and reduces left ventricular volume by placing three sutures through the trabeculae around the bases of the anterior and posterior muscles, Diane Barker, M.B., said at the annual congress of the European Society of Cardiology.
The procedure, which involves graded placation of the papillary muscle through a small, apical incision, usually takes about 15–20 minutes, said Dr. Barker, a cardiologist at Leeds (England) General Infirmary. The suturing also reduces functional mitral regurgitation. It is generally combined with coronary bypass grafting.
Unnikrishnan R. Nair, M.B., who developed the new technique, has used it to treat 30 patients in Leeds since 1998. Follow-up has ranged from 12 to 58 months, with an average of 28 months. One patient died within 30 days of the procedure from sepsis. Another patient developed atrial fibrillation following surgery. All of the other patients had improvements in their left ventricular function and in their clinical status, and none developed ventricular arrhythmias, Dr. Barker reported. Three patients died 4–24 months following surgery, but the deaths appeared unrelated to surgery. The average age of the patients was 61 years, and three-quarters were men. All of the patients had ischemic cardiomyopathy. The average left ventricular volume of patients before the surgery was 271 mL; after surgery, 230 mL. Before surgery, the patients had heart failure with an average New York Heart Association functional classification of 2.8; after surgery, the average was 1.4.
To better assess this surgery, Dr. Barker and Dr. Nair compared 8 patients who underwent suturing of papillary muscle plus bypass surgery with 32 similar patients treated with bypass surgery only. (See box.)
Exercise duration improved among patients who underwent papillary muscle suturing compared with those who had bypass surgery only. Peak oxygen capacity rose among the patients treated with papillary muscle suturing compared with those who had bypass surgery only. Cardiac reserve rose among patients treated compared with the control group.
The next step is to test the surgery's safety and efficacy in a randomized, controlled study, Dr. Barker said.
This image shows the placement of the sutures through the trabeculae.
This image shows the sutures being tied in the novel procedure.
This image shows the surgical incision being repaired. Photos courtesy Dr. Unnikrishnan R. Nair
