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Left Ventricular Reconstruction and Conventional Surgery for Cardiac Failure

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Cardiac Surgery

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Abstract

Congestive heart failure is associated with poor survival despite optimal medical therapy. In ischemic cardiomyopathy the left ventricular remodelling after transmural myocardial infarction may lead to dilated with or without dyskinetic aneurysm development. Surgical ventricular reconstruction (SVR) can restore left ventricular shape and lead to a functional recovery of the patient. Exact preoperative planning including MRI studies is essential for proper LV volume reduction during surgery. In many patients, additional coronary arterial bypass grafting and mitral valve surgery need to be performed.

Post-infarction ventricular septal defect (VSD) occurs in <1 % of transmural infarctions. In haemodynamically stable patients, surgery should be postponed to allow scar healing of the unstable edges of the infarction tissues. In haemodynamically instable patients, surgical or interventional VSD closure is the only cure but is associated with substantial mortality and morbidity. Surgical patch closure is the preferable technique. Interventional VSD closure might act as palliation in very unstable patients even though frequently observed residual shunts will require later surgical cure.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, University Medical Center Freiburg, Freiburg, Germany

    Friedhelm Beyersdorf MD, PhD

  2. Department of Cardiovascular Surgery, University Heart Center, University of Freiburg, Freiburg, Baden-Wuerttemberg, Germany

    Matthias Siepe

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  1. Friedhelm Beyersdorf MD, PhD
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  2. Matthias Siepe
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Correspondence to Friedhelm Beyersdorf MD, PhD .

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Editors and Affiliations

  1. Department of Surgery, The University of Chicago, Chicago, IL, USA

    Gerhard Ziemer

  2. HTTG - Surgery, Medizinische Hochschule Hannover, Hannover, Germany

    Axel Haverich

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Beyersdorf, F., Siepe, M. (2017). Left Ventricular Reconstruction and Conventional Surgery for Cardiac Failure. In: Ziemer, G., Haverich, A. (eds) Cardiac Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52672-9_23

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  • DOI: https://doi.org/10.1007/978-3-662-52672-9_23

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