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 muscles 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.
This approach was developed when surgeons in Leeds became dissatisfied with the morbidity and mortality associated with the Batista procedure, which involves resection of myocardium from the left ventricular free wall.
Unnikrishnan R. Nair, M.B., who developed the new technique, has used it to treat 30 patients in Leeds since 1998. Follow-up for the patients has ranged from 12 to 58 months, with a mean of 28 months. One patient died within 30 days of the procedure from sepsis. One other 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 additional patients died 4-24 months following surgery, but none of these deaths appeared related to surgery. The average age of the patients was 61 years, and three-quarters were men. All of the patients had ischemic cardiomyopathy.
The mean left ventricular volume of patients before the surgery was 271 mL; after surgery, the average volume was 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 functional class was 1.4.
To better assess the impact of this surgery, Dr. Barker and Dr. Nair compared the outcomes of 8 patients who underwent suturing of their papillary muscles plus bypass surgery with 32 similar patients who were treated with bypass surgery only. (See box.)
Exercise duration improved by a mean of 33% from baseline among patients who underwent papillary muscle suturing, compared with a mean improvement of 18% among patients who had bypass surgery only. Peak oxygen capacity rose by a mean of 21% among patients treated with papillary muscle suturing, compared with an average rise of 9% among patients who had bypass surgery only. And cardiac reserve rose by a mean of 168% among patients treated with papillary muscle suturing, compared with a mean increase of 14% in the control patients.
The next step in development of the surgery is to test its safety and efficacy in a randomized, controlled study, Dr. Barker said.
Three sutures are placed through the trabeculae during the novel procedure.
The sutures are being tied to realign the papillary muscles of the left ventricle.
The small, apical incision is being closed after the 20-minute procedure. Photos Courtesy Dr. Unnikrishnan R. Nair